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Preparing for CJR: Academic Medical Centers and Medicare Mandatory Joint Bundles AAMC Alternative Payment Team January 19, 2016
1. National Context Agenda 2. CJR Program a. Highlights b. Preparing Your Organization for Implementation 3. AAMC Work in Alternative Payments a. BPCI Lower Joint Replacement b. CJR Program Work to Date c. Next Steps 4. Questions
National Context FFS APMs
CJR Overview Hip and knee replacement bundle with hospitals as the only initiator DRGs 469 and 470 Anchor hospitalization + 90 days post-discharge Medicare Part A & B services Retrospective annual reconciliation Five-year performance period begins April 1, 2016
Setting Your Target Price Targets are based upon 3 years of historical data Updated every other performance year Based on a blend of hospital and regional data Stratified by fracture status Discounted by 2% to produce Medicare savings Quality metrics predict final discount to CMS Premier, Inc., 2015
You are in 1 of 3 groups: How CJR Affects You Check here to see if your hospital is in a CJR MSA: https://innovation.cms.gov/initiatives/cjr
Implementing CJR: Immediate Steps #1) Request your data!
Hospital Hospital 90 Days Readmission Readmission IP Rehab HHA A HHA B Readmission HHA Readmission SNF SNF HHA HHA B What happens to patients after discharge SNF C HHA C SNF A HHA C Readmission SNF HHA Readmission SNF Readmission HHA SNF HHA C HHA E Readmission HHA C Readmission Readmission HHA HHA A SNF Before Bundled Payments Readmission SNF HHA SNF Under Bundled Payments
Select and Receive All Possible Data http://catalyst.nejm.org/ To request data email CMS: CJR@cms.hhs.gov
> 1 month
#2) Convene your team. Project management Analytics Clinical leadership BPCI Committee Legal Finance / contracting
#3) Develop post-acute care strategy.
#4) Explore gainsharing options. CMS allows both gainsharing and sharing of downside risk in CJR. Both of these amounts are subject to a cap. Gainsharing Payment Participant Hospital CCJR Collaborator Alignment Payment
AAMC as Facilitator Convener Learning Collaborative Advocacy Policy Analysis Data and Clinical Analyses Project Management
AAMC s BPCI Health Systems Washington Montana Vermont Maine North Dakota Minnesota Oregon California Nevada Idaho Utah Arizona Wyoming Colorado New Mexico South Dakota Nebraska Kansas Oklahoma Iowa Wisconsin Missouri Arkansas Illinois Michigan Indiana Kentucky Tennessee Ohio New York Pennsylvania West Virginia North Carolina South Carolina New Hampshire Massachusetts Rhode Island Connecticut New Jersey Delaware District of Columbia Maryland Virginia Georgia Current Participants Texas Florida Louisiana Mississippi Alabama
Our Teaching Hospitals BPCI Episodes Major joint replacement - lower extremity (19) CHF (7) CABG (4) Cardiac valve (4) Stroke (4) Cervical spinal fusion (3) COPD (3) Spinal fusion (non-cervical) (3) Double joint replacement - lower extremity (3) Major bowel procedure (2) Live as of October 1, 2015
AAMC CJR Work To Date Hospital-specific data reports prepared by DataGen Rule summary Quality performance projections BPCI to CJR switch tools Customized consultations Highly successful CJR Boot Camp (October 9, 2015)
HANYS CJR Boot Camp with DataGen & AAMC February 18, at the New York LaGuardia Airport Marriott in East Elmhurst, N.Y. MANHATTAN QUEENS BROOKLYN
HANYS CJR Boot Camp with DataGen & AAMC Attendees can expect: AMC colleagues as guest speakers with bundling expertise in LEJR Practical steps and templates to use in CJR/bundled payments at your organization Group work on key elements of LEJR bundles using a practical case study Your organization s LEJR data report Flash drive with full day s materials Register now! http://www.hanys.org/cjr-bootcamp/
AAMC CJR Collaborative Group Share best practices Program implementation tools Education and group learning Strategic consultation informed by policy and data analyses Advocacy on key policy issues for AMCs with CMS Customized consultation Data management and analysis
Data Services Data received by your hospital: Flat text files Specific file for each provider type Claims not pro-rated Exclusions not applied
AAMC CJR Collaborative Group AAMC CJR Collaborative Group Start date of March 1: Your organization will receive an AAMC CJR Starter Kit: CJR project plan How To Manual: Implementing Bundled Payments Customized quality performance projections AAMC Alternative Payment Website access April 1 and Beyond: Baseline data analyses AAMC educational webinars Address program and policy concerns Individual consultative phone calls with AAMC team
AAMC CJR Collaborative Group
Questions? Please use the Q&A panel located on the right hand side of your screen to submit your questions. Send to All Panelists.
For more information, please contact us at AAMCBundledPayments@aamc.org