After months of opening its proposed rule to public comment, and adding 600 pages to the rule as a result, CMS has released the Final Rule for Comprehensive Care for Joint Replacement (CJR). This first-of-its-kind mandatory bundling program will hold participating hospitals accountable for episodic spending performance on eligible Medicare fee-for-service joint replacement patients.
This research note provides a summary of the changes coming with the final rule, along with recommendations for what CFOs can do now to ensure their organizations are meeting quality thresholds.
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- National expansion may be closer than you think: Hospitals not involved in the program are advised to watch the CJR results as they unfold. This pilot is designed to test the potential for cost savings and quality reduction, and if the results prove positive for CMS, it's a solid bet the program will encompass additional markets in the near future.
- Quality must be a focal point: CMS has finalized a methodology that softens the spending reduction requirements for organizations with top-notch quality performance. At the other end of the spectrum, middling and low performers face the prospect of tougher spending reduction targets and limited-to-no upside potential.
- Collaboration essential for success: Local market partnerships with physicians and post-acute care providers are taking center stage. Acute care hospitals must cultivate relationships that foster collaboration to create an efficient care standard that improves outcomes while reducing low-value utilization.