Last Friday Archway Health hosted a joint webinar with Foley & Lardner LLP titled “Get Ready for the Comprehensive Joint Replacement Program—The Time Is Now.” The webinar is part of a Bundled Payment Best Practices webinar series. Presenters:
- Dave Terry, CEO, Archway Health
- Christopher Donovan, Partner, Foley & Lardner LLP
- Frederick Geilfuss II, Partner, Foley & Lardner LLP
You can find a video replay of the webinar and a copy of the slides here.
Here’s our recap:
First, Foley & Lardner presented an overview of CJR. In the CJR model, “acute care hospitals in certain selected geographic areas will be responsible for the costs of episode of care for extremity joint replacement or reattachment of a lower extremity (and, as proposed, surgical hip/femur fracture).” The episode of care “covers all Medicare Part A and Part B payments from hospitalization through 90 days post-discharge.”
The CJR program began on April 1, 2016 and is already mandatory for around 800 hospitals in 67 metropolitan statistical areas. The financial model for CJR is a retrospective, two-sided risk model where hospitals bear financial responsibility. At the end of each performance year, “actual episode spending will be compared to the episode target price.” Once this comparison is made, the hospital will receive reconciliation payments if their costs were below target and they will be responsible to repay CMS if their costs were above target. CMS sets these target prices based on historical data. Downside risk will begin on January 1, 2017. CJR is scheduled to be a five-year program.
In the webinar, Foley & Lardner went into detail on how target prices are established and discussed rules governing sharing agreements. They also talked about program waivers for CJR, including some that we have seen in other CMS programs.
After introducing Archway Health and our holistic approach to bundled payment, Dave Terry then gave insight into bundled payment program design and the current state of the bundled payment market. It is clear that bundled payment is no longer a niche payment model, but rather, an important priority in provider strategy. For one thing, CMS continues to push bundled payment models forward. Another sign of the continuing growth of bundled payment is that employers are starting to ask for it. Bundled payment is not going away. It is already starting to change the way that providers get paid.
The Archway approach to CJR is a three-phase process of preparation, design, and implementation.
Phase 1 is Program Preparation. The main objective of this phase is to identify the priority areas of focus. To do this, we run analysis on episodic spending by surgeon and by post-acute provider, quality performance, and pricing to identify key areas of opportunity. One mistake that providers make is trying to do everything at once. Instead, providers should let the data guide them to one or two areas to select as areas of focus.
Once the areas of focus have been identified, it’s time to build one really good team, not multiple teams, to work on that area. That’s why Phase 2 is Program Design. The main objective of this phase is to finalize the CJR strategy and operational plan. During this phase, the practice will designate and train a CJR Oversight Team. This team will carry out the work plan that will be defined during this phase. Key team members may include joint class leaders, a care management leader, a discharge planning leader, a surgeon champion, and representatives from the financial department and C-suite. The practice will also develop a gainsharing strategy and formalize a preferred provider network.
Phase 3 is Program Implementation. Though preparing and designing the program lays the foundation, we spend the most time in the actual implementation. The main objective is to improve quality and reduce costs. Implementation involves ongoing learning and improvement. Identifying and tracking CJR patients is an important part of program implementation. At Archway, we have developed a care management model called the INACT process. We also make patient tracking and financial performance available on an online platform.
Are you preparing for CJR? To learn more about Archway’s three-phase CJR model implementation plan, please contact us at email@example.com.