CMS releases 4th CJR data feed — Expectations and surprises

Practice Management

In April, CMS released the fourth data feed from the Comprehensive Care for Joint Replacement Model. The CJR is CMS' first mandatory bundled payment initiative, with a focus on hip and knee replacements. This data feed covered episodes beginning in the second quarter of 2016 through early 2017.

Initially, CMS released data feed quarterly, but recently decided to start releasing feeds every month. Many hospitals expected episode counts and episode average spend to remain static, since both features remained stagnant between the second and third feeds.


But, some hospitals received an unwelcome surprise in the fourth data feed, as CMS decided to remove any episodes falling under Bundled Payments for Care Improvement participation.


"CMS did tell us it may [remove BPCI episodes], but we didn't know until right before the data came out," explains Kelly Price, vice president and chief of healthcare data analytics at Rensselaer, N.Y.-based DataGen. "Some [hospitals] were aware that they would lose a big chunk of volume, but not all of them."


With the removal of BPCI volume, average episode cost increased slightly. This boost did not surprise Ms. Price, who commented that a committed physician group likely heavily managed the lost episodes.


Ms. Price and her team have been analyzing the CJR data feeds since CMS' first release in August 2016. DataGen analyzes data for 64 episode-initiating hospitals. For the second and third quarters of 2016, the data included 5,500 episodes.


Of the 64 hospitals analyzed, 12.5 percent lost all of their volume when CMS pulled BPCI episodes. Moving forward, Ms. Price recommends hospital senior leadership hones in on BPCI management to understand which episodes will count toward CJR.


Ms. Price and her team also analyzed the first CJR reconciliation:


  • Forty-three of the 64 hospitals received savings and will be receiving checks from CMS.
  • Thirty-one hospitals reached the 5 percent stop-gain cap. 
  • Twenty-seven hospitals earned a score of  "excellent" on the quality metrics, changing discount factors from 3 percent to 1.5 percent.


Variants to the target proved surprising to many of Ms. Price's clients during the reconciliation process. Moving the target and average episode spend just slightly produced significant changes in variants.


"A very small change in episode spend or target can produce a huge swing in the variants; you can have a 100 percent change in variants due to a 1 percent change in spend or target," explains Ms. Price.


Understanding the impact of slight target and spend changes is critical to expectations for the true-up of this reconciliation in early 2018, Ms. Price emphasizes. Although targets will likely remain the same, average episode spend will likely increase slightly, which has the potential to cut reconciliation in half or even move a hospital from a gain to a loss.


"Since [hospitals] were very focused on the variant, these little swings in target and spend produced a huge change in the numbers they had focused on," concludes Ms. Price.


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