Industry Insights

Hospitals Not Subject to CJR Should Pay Attention to the Model

April 2016
Author:  William Clark

William Clark

Director

Consulting

Health Care

Two Warren Place
6120 S. Yale Avenue, Suite 1400
Tulsa, OK 74136-4223

Tulsa
918.584.2900

Providers in the 67 metropolitan statistical areas selected for the Comprehensive Care for Joint Replacement (CJR) bundled payment demonstration project should be preparing for the program’s effects on their organization. Those not subject to the program also should be educating themselves on the CJR and bundled payment models, since the U.S. Department of Health and Human Services (HHS) plans to transition 50 percent of traditional fee-for-service Medicare payments to advanced payment models (APM) by the end of 2018.

With the use of APMs expected to increase, hospitals not participating in CJR should evaluate their episodes of care for diagnosis-related groups likely to be included in a future bundled payment arrangement.

Areas to evaluate include:

  • Total costs and spending breakdown for a 90-day episode of care, including physician, inpatient psychiatric, long-term care hospital, inpatient rehabilitation, skilled nursing, home health, hospice, hospital outpatient and laboratory services as well as hospital readmissions, outpatient therapy, durable medical equipment and part B drugs
  • Cost comparison to other regional providers
  • Most frequently used post-acute care providers

With the right data, forward-thinking providers can successfully prepare and plan for APMs.

For more information on how you can prepare for APMs, contact your BKD advisor.

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