Hip and knee replacement is the most common inpatient surgery for Medicare beneficiaries and can require a long recovery and rehabilitation. The Centers for Medicare and Medicaid Services (CMS) estimates that in 2014 there were more than 400,000 procedures, costing more than $7 billion for the hospitalizations alone. With such a large expenditure and estimates that this utilization will continue to grow, CMS began to assess the quality and cost of care for these procedures and recognized that there is great variability across the country in complications, readmissions, infection rates, lengths of stay and many other patient outcomes. This large variability in patient outcomes results in tremendous variation in Medicare payment for this procedure. CMS indicated that the average total Medicare expenditure for surgery, hospitalization and recovery ranges from $16,500 to $33,000 across geographic areas.
It is CMS’ belief that this range can be attributed to the fragmented healthcare that its beneficiaries receive. This fragmented care is the result of the medical/surgical/rehabilitation teams not coordinating their care across different care settings.
By coordinating the care between providers for these hip and knee replacement patients, CMS believes it will achieve multiple goals including:
- improve the surgical outcomes;
- reduce total Medicare expenditures and
- work toward the Department of Health and Human Services goal of ultimately shifting 50% of Medicare Fee-For-Service payments into value based alternative payment models by the end of 2018.
With this background, on November 15, 2015, the Centers for Medicare and Medicaid Services (CMS) released final regulations implementing the Comprehensive Care for Joint Replacement (CJR) model. This toolkit will provide information on the CJR model. For those practices that are required to participate in this bundled payment model, this toolkit will describe which patient populations are subject to the model, the implications for the anesthesia practice and how to prepare for the implementation. It will also be useful information for those anesthesiologists who are currently not subject to this requirement, providing information about this model of care and reimbursement as a way to prepare for other bundled and alternative payment models.