In the face of the most significant change in reimbursement that the orthopedics industry has ever seen, over half of surveyed hospital orthopedic programs nationwide (56%) have reported feeling unprepared for the new Medicare bundled payment model that goes into effect April 1, 2016, and less than 10% report being “fully” prepared. The data, based on a survey of more than 100 orthopedic departments in hospitals across the United States, was conducted by Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) and Wellbe, Inc.
On April 1, Centers for Medicare & Medicaid Services (CMS) will launch its first mandatory bundled-payment initiative, the Comprehensive Care for Joint Replacement (CJR) Model, and for the first time will link payment to quality and patient satisfaction measures in addition to cost measures. The aggressive approach is expected to improve patient outcomes and control costs, and will be focused on one of the most expensive and common procedures: total hip and knee joint replacements.
Under the new CMS program, providers will be on the hook to track quality and prove value in patient care and will be accountable for the cost of joint replacement care from the time of surgery through 90 days after discharge. CMS will tie each hospital’s reimbursement to a composite quality score based on three measures including patient-reported outcomes (PROs) — which measure the function and pain that a patient experiences before and after care – for the first time assessing the success and quality of care from the patient’s perspective.
“Many of the 789 hospitals participating in the new program may find themselves scrambling to figure out how to clinically and operationally manage once the rule goes into effect,” said David Ayers, MD, co-lead of FORCE-TJR and chair of the Department of Orthopedics and Physical Rehabilitation at UMass Medical School. “Surgeons who have been participating in FORCE-TJR for the last four years however, have already been using an episode management system based on patient-reported outcomes to successfully optimize patient care and report quality metrics.”
Tracking and understanding the complete episode of care is critical in order to obtain the most accurate data. For instance, in tracking more than 25,000 joint replacement patients, FORCE-TJR showed that hospitals are at risk for underestimating readmission costs by 25% because one out of every four patients who have a readmission do not return to the hospital where they had their original surgery. Not having such information could have significant impact on a provider’s bottom line under the CJR value-based contract.
FORCE-TJR national benchmarks can provide a “diagnostic” assessment of a hospital/surgeon practice readiness for CJR and exposure to factors that drive the cost and quality score. The data can show how patients’ pre-op risk factors or readmission rates compare to national norms and how risk-adjusted patient-reported outcomes or post-discharge complications compare. Using the practice’s own historical data, FORCE-TJR can clarify steps needed to be taken to be a successful participant under CJR.
The survey also found that a majority (75%) of respondents are actively planning to hire new staff in order to meet the demands of coordinating patients and collecting data across the episode. Nineteen percent reported that they are planning to invest in systems that will allow them to track and report patient-reported outcomes.
“When faced with new requirements and increased risk, most hospitals are inclined to hire more staff to manage patients across the episode of care,” said James Dias, CEO of Wellbe. “However, as new rulings are introduced, leaders would be better served by thinking more creatively about empowering patients and their families with digital tools to be connected participants in their care – they can be your most productive and effective members of your care team.”
To download a copy of the survey results, visit https://www.orthoserviceline.com/CJRsurvey.
About FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) – FORCE-TJR is a comprehensive arthroplasty value management system that helps orthopedic surgeons and hospitals successfully optimize patient care and report quality metrics. FORCE-TJR provides surgeons and hospitals real-time, individual peri-operative patient risk assessments, including patient-reported outcome (PRO) data, that allows for risk-based patient management in the 90 day period to minimize adverse events and assure best outcomes. Aggregate data provide comprehensive, practice feedback to improve and manage patient care, meet payer reporting requirements, compare performance to peer surgeons/ institutions, and secure quality incentive payments. FORCE-TJR data and methods were established under a $12 million grant from the Agency for Healthcare Research & Quality. With a PRO completion rate of 85%, FORCE-TJR has the only risk-adjusted, US national benchmarks for adverse events, PROs, and early implant failure in both CMS patients, and the 45% of TJR patients who are under 65 years of age. http://www.force-tjr.org/
About Wellbe (http://www.wellbe.me)
High-performing health systems use Wellbe’s Integrated Care Delivery to move from fragmented silos of care to value-driven service lines. Our web-based platform enables patients to participate as partners in their care while giving providers the ability to coordinate and monitor large patient volumes more effectively. Wellbe’s track record at hospitals across the U.S. shows that engaging patients in a coordinated plan of care that’s based on Connected CarePaths™ across the continuum results in reduced episode costs, higher patient satisfaction, fewer readmissions, and improved outcome scores.
