Issue link: https://viewer.e-digitaledition.com/i/556451
MEDICARE (CMS) CONTINUES TO WORK ON EVOLVING ITS VARIOUS PAYMENT MODELS BOTH TO IMPROVE QUALITY AND COORDINATION OF CARE AND TO REDUCE HEALTHCARE COSTS. MOST MODELS HAVE BEEN VOLUNTARY OR INVOLVE FINANCIAL PENALTIES OR REWARDS BASED ON SPECIFIED METRICS. On July 14, Medicare published its proposed rules for the Comprehensive Care for Joint Replacement Program (CCJR). Under this mandatory program, CMS would bundle payments for nearly all Part A and B services related to hip and knee replacement surgeries performed at hospitals located in 75 selected metropoli- tan statistical areas (MSAs). The program begins Jan. 1, 2016, with an initial term of five years. Summit and Portage Counties are included in the selected MSAs, as well as counties in the Cincinnati and Toledo areas. The program is expected to subject approximately 800 hospitals to CCJR. At those hospitals, approximately 110,000 annual procedures will be impacted by this new program. CMS estimates this program will result in $153 million in savings. Limited to MS-DRGs 469 and 470, the care episode will start on the day the Medicare patient is admitted for hip or knee replacement surgery and will continue for 90 days following the patient's discharge from the hospital. All Part A and B services furnished to the patient during this period will be included in the care episode. Hospitals will bear the financial risk for the total cost of care by all providers. How will CCJR work? Individual prov iders w ill cont inue to submit claims for services furnished during a covered episode of care. CMS will pay these claims. Annually, CMS will compare the actual total cost of care for all episodes provided at a hospital to the hospital's predetermined episode target price. If the actual cost is less than the target price, the hospital will receive a reconciliation payment equal to the difference. If the actual cost is more than the target price, the hospital will be required to pay the difference to CMS. Quality measures also must be met to receive reconciliation payments. These measures include: 1. Hospital-level risk-standardized com- plication rates, 2. Hospital-level 30 day all-cause risk- standardization readmission rates, and 3. Ye t- t o - b e - s p e c i f i e d H o s p i t a l Consumer Assessment of Healthcare P ro v id er s a nd Sy s t em s Su r v e y (HCAPH) measures. CMS encourages the hospita l to enter into CCJR sharing arrangements with CCJR collaborators. The CCJR collaborators would agree in writing to participate in specific quality and efficiency initiatives relating to the episodes in exchange for gainshar- ing payments. Providers in the selected MSAs need to thoroughly review the proposed regulations and respond to CMS dur- ing the comment period which ends Sept. 8, 2015. In addition, they should begin work now to establish their CCJR programs and collaborations. Other specialties need to pay close attention to the progress of this program which may be expanded to specialties other than orthopedics. Martha S. Bethea is a CPA and the Manag ing Director in charge of the Medical Practice Management Group of CBIZ/MHM LLC in Akron, Ohio. ■ By Martha S. Bethea, CPA ++++++++++++++++++++++++ +++ + +++ + ++++++++++++++++++++++++ ❮ MEDICARE UPDATE Medicare Payment Models — Bundled Payment Initiatives 2 0 1 5 S E P T E M B E R /O C T O B E R ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 2 5