The April 1 start of the Comprehensive Care for Joint Replacement (CJR) payment model could spell bad news for the 60% of participating hospitals that are likely to lose money.
But it’s also a “tremendous opportunity” for home health agencies, according to CareCentrix CEO John Driscoll.
Hartford, Connecticut-based CareCentrix acts as a partner for home health agencies and serves health plans in managing the post acute benefit. Currently, the company is seeking to help home health agencies understand, and maximize, their role in the new payment model.
The CJR initiative, first announced last July, represents a new approach to payment reform from the Centers for Medicare & Medicaid Services (CMS). As part of the plan, hospitals in affected regions will be responsible for Medicare spending on knee and hip replacement episodes of care, including hospital and post-hospital expenses. If spending exceeds specific thresholds—based on the hospitals’ past spending and that of its regional peers—Medicare penalties could ensue.
Essentially, the new CJR program means that hospitals must manage to a budget, Driscoll told Home Health Care News. Managing to a budget creates a huge opportunity for home health agencies, he said—as long as the home health agencies know how to manage care transitions. In these care transitions, they can demonstrate the best of what home health has to offer.
“We think the CJR is a tremendous opportunity for home health agencies to showcase the best of their work,” Driscoll said.
Simply put, CJR creates a strong economic incentive to keep home health agencies in the care loop earlier and longer, Driscoll said.
The new payment model also creates a fresh opportunity for home health agencies to do more with patients before and after the hospital, Driscoll said, citing physical and occupational therapy.
There’s no question that this payment change has come more quickly than expected, but home health agencies can—and should—assume a lead role in the process, Driscoll said.
“I strongly recommend that home health agencies create partnerships to optimize their role in the care loop,” he said. And that can be accomplished using data.
“Data is critical to be able to manage to the new budget standards,” Driscoll said. The availability of data and analytical tools allow for truly identifying the optimal clinical path, as well as the best combination of agencies and institutions that can get patients the best care at the lowest price, he said.
Written by Mary Kate Nelson