Intralign CCJR Infographic
- 1. 1. CMS sets target prices based on a blend of regional and hospital average historical episode payments minus a Medicare savings discount. 2. Hospitals will continue to be paid fee-for-service. 3. Payments are reconciled against target prices at end of year. To receive Reconciliation Payments, hospitals must show improvement across 3 quality metrics: 1. Readmission rate 2. Complication rate 3. HCAHPS Survey Maximum Net Payment Reconciliation Amounts (NPRA) = 20% of Target Prices Overview: Comprehensive Care for Joint Replacement (CCJR) Bundled Payment Model What’s CCJR? CMS’ new mandatory bundle payment program that incentivizes hospitals to improve the quality and cost of Medi- care patients undergoing total joint replacement – from surgery to recovery (up to 90 days, post-discharge). CMS Orthopedic Bundled Payment Programs By 2018, 50% of Medicare payments will be tied to quality. CCJR Program: Includes an estimated 700 hos- pitals across 75 regions. Medicare anticipates a savings of $153 million over 5 years. In 2013 there were more than 400,000 Hip & Knee replacements for Medi- care, costing $7B for inpatient care alone. What’s the provider impact? How will the hospital get paid? How does the hospital prepare for CCJR? For more information on managing the episode of care under a CCJR bundled payment initiative, visit www.intralign.com or contact # 602-773-5806 3. Execute: • Execute post-acute contracts • Care re-design implementation • Ongoing data capture/ management 2. Strategize: • Care re-design & coordination • Post-acute partnerships • Data sharing/ gainsharing • Patient Reported Out- comes data 1. Assess: • Structure & governance • Obtain & analyze his- torical Medicare service utilization/episode reimbursement • Post-acute network US Hospitals remain- ing-not in bundled payment 75.8% 700 hospitals in CCJR 20.4% 130 in BPCI 3.8% Jan 1, 2016 Year 1 (Reconciliation vs. target price. Only "upside" payments in Year 1) Year 2 Year 3 Year 4 Year 5 2021 (Volume x Target Prices) - (Volume x Actual Yr 1 Payments) = Target Price Below target price, hospital must repay Medicare (no risk year 1). Above target price, hospital receives a Reconciliation Payment. Additional 0.3% bonus: Tracking patient reported outcomes Inpatient (55% spend) 3-Days Prior ------------> Hospital Discharge Post-Acute (45% spend) Post-Discharge Day 1 ----> Day 90 Post CCJR Payment Episode The hospital is responsible for managing to episode Target Price and improving quality of care Pre Coordinated care for discharge to optimal post-acute care (PAC) setting starts here. Hospitals will own responsibility for directing and managing the patient pathway to a network of PACs. Hospitals will be challenged to manage the services & quality across many different providers to meet CCJR goals.