New Joint-Replacement payment program for some hospitals

Aims to improve quality and cost of care

Medicare will implement new system for hospitals performing hip and knee replacements, which are the most common surgeries among Medicare beneficiaries. If hospitals don’t meet the standards, they will have to pay back a part of the cost to Medicare. If they do perform well, they will get a monetary reward.

What is the new program?
The Comprehensive Care for Joint Replacement model (or the CCJR model) aims at better quality care. It will begin April 1, 2016.
67 geographic areas are included in the program. The Staunton-Waynesboro area is the only one in Virginia.

How does it work?
Hospitals will be evaluated for an “episode of care,” which lasts 90 days after the surgery. The cost of the episode of care, including the procedure and any related care, is in question for the hospital.

If the hospital’s care doesn’t meet the cost and quality standards, they will owe Medicare for a portion of the cost for the episode of care. If they succeed, Medicare will give the hospital a financial reward.

The program is meant to create incentives not only for hospitals, but skilled nursing facilities, nursing homes, and other health providers to providing comprehensive, coordinated care.

Why start this program?
The Centers for Medicare and Medicaid Services say on their website that these surgeries are the most common among beneficiaries, but the care varies from hospital to hospital. They want to not only coordinate the quality of care and its costs, but improve care nationwide. The inconsistencies in the health of patients after these surgeries reflects the state of the entire health care system.