On April 1st, in 67 Metropolitan areas, Medicare will change the way it pays for joint replacement procedures with DRG 469 or 470 in prospective payment hospitals. While the new payment methodology only applies in these 67 areas, (to see if your area is included click here), the program is likely to have an impact across the country. Under the program, Medicare will establish a target price for an episode of care that begins when the patient is admitted to the hospital and ends 90 days following the patient’s discharge. The hospital will be responsible for managing costs to meet the target price. If the costs exceed the target, the hospital must repay Medicare. If the costs are lower than the target, the hospital receives a payment from Medicare. Additionally, quality criteria can increase or decrease the payment. Hospitals are permitted, but not required, to share risk with other entities providing care during the 90 day window.
This webinar will give an overview of the CJR program. While the session will not go into mathematical detail about how the payments or quality metrics will be calculated, it will provide a sense of how the program works, and explore possible implications for hospitals, physicians, therapists and SNFs both in the MSAs covered by the program and in the rest of the country. We will also discuss gainsharing; how it can be used as part of CJR and how hospitals and physicians can use gainsharing in other parts of the country.