What the 1st CJR data feed revealed & how providers can leverage it for best practices

Practice Management

CMS recently released the first data feed of the Comprehensive Care for Joint Replacement Model, which reflected updates and corrections to the previously released baseline files.

The data feed includes episodes beginning in April, May and June, explains Kelly Price, vice president and chief of healthcare data analytics at Rensselaer, N.Y.-based DataGen.PRICE 294


Ms. Price notes CMS altered the data's format, in response to the needs of the program's participants. For example, the new format includes a wage adjustment and a wage standard.

This initial feed, however, does not offer a full set of all claims in the episodes, because episodes beginning after April 1 ended in July or August, after the feed cut. In addition, participants won't have a full count of episodes for June because the anchor claims for episodes beginning later in June will not have been submitted and paid by July 1. Therefore, hospitals are only analyzing less than half of anchor claims for June episodes.


"You cannot look at the data and try to get a picture of your expected financial performance compared to your target, because you're going to look like you're doing well," says Ms. Price. Essentially, hospitals should not use this initial data feed to measure financial performance.


Although this data feed doesn't allow financial performance analysis, hospitals may still utilize the data for certain types of evaluation of the April and May periods. Under the CJR, providers must accurately identify patients starting an episode under their care in order to provide the required beneficiary notification. This data reveals whether providers proved successful in this task, and if not, allows them to zone in on improvement areas.


Additionally, providers may want to examine their April episodes, evaluating whether they followed the strategies they put in place for post-acute care. This strategy evaluation will prove helpful when the second 2016 data feed rolls around, likely released in October or November.


"One you get to a point where you can evaluate financial performance, in order to predict whether you will continue to do well, you'll have to know whether a result is the outcome of a strategy you put in place or if it was just random," Ms. Price explains.


The opportunity for episode cost reduction lies in properly coordinating post-acute services. Ms Price recommends healthcare organizations focus on streamlining care, reducing length of stay and sending patients to appropriate settings.


"Before now, there was no incentive to not send anyone to rehabilitation or SNF," says Ms. Price.


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