The joint replacment bundle (also known as CCJR or CJR) affects 800+ hopsitals this year, and counting. What does this mean for these CJR mandated hospitals? Get back to basics with this introductory post on the fundamentals of bundled payments.
With the widespread introduction of Medicare bundled payments in 2016, hospitals are more accountable than ever for the care a patient receives. It is now the hospital’s responsibility to ensure that the entire defined episode of care (from admission through to 90-days post-discharge) meets the required quality of care and budget allocated for the procedure. Take for example the joint replacement bundle, Comprehensive Care for Joint Replacement (CJR, formerly called CCJR). Despite many caregivers involved in the episode of care, it is the hospital who is ultimately held accountable for the success of the joint replacement and total cost. The major caveat is that even though the hospital is held responsible for the entire episode of care, each caregiver (like a physical therapist or skilled nursing facility) bills Medicare directly under “fee for service”.
In other words, the hospital who must ensure the quality is high and the spend does not exceed the set target, does not control what is being billed. The hospital does not have billing visibility for each caregiver in real-time. The payment is a retrospective, end-of-year reconciliation with financial consequence placed solely on the hospital.
This article was originally published on PeerWell--a PreHap app that helps you prepare for and recover faster from joint replacement surgery.
