Think You're Ready for CJR? Read Between the Lines

Since the Comprehensive Care for Joint Replacement (CJR) model launched in April, MedAssets-Precyse has identified inconsistencies in program rules, specifications, allocation rates and benchmarking data provided by the Centers for Medicare and Medicaid Services (CMS). This could impact your ability to manage episode costs and quality performance, so it is important to know where there are discrepancies.

Here's what you need to know as you move forward:

1) The target price provided by CMS may not match CJR target price specifications – This is a problem because it can and will impact your visibility regarding appropriate spend for home health. To gain clarity, ensure that your post-acute home health spend has been identified correctly before moving forward. Double check you costs for Home Health Aide (HHA), the most affordable option, and Skilled Nursing. In either case, there are errors in the CJR calculation for applying the two percent sequestration to SNF payment during the baseline period. Inconsistencies also exist in the application of proration to outpatient claims, so this is another area to watch.

2) Regional benchmark data from CMS can be misleading – Because CMS has combined acute care payments with readmissions and post-acute care payments, this can fog your view on post-acute care spend by masking payment variations between services. It is important to evaluate the shift in service-level cost and quality with financial impact to accurately gauge your program's overall performance.

MedAssets-Precyse can help you identify CJR inconsistencies to avoid risk and gain the most benefit from the program. To receive a copy of "Managing CJR Risks in Post-Acute Care that You Don't Control" click here. To speak with a specialist contact us at solutions@medassets.com, or call 678.323.2500.


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