Redesigning your total joint care: Preparing for the future of healthcare, including the proposed Comprehensive Care for Joint Replacement model


The Center for Medicare and Medicaid Services (CMS), announced that beginning April 1, 2016, the Comprehensive Care for Joint Replacement (CJR) Model will institute mandatory bundled payments for the Total Joint episode of care in 67select Metropolitan Service Areas. As total joint replacements are the most common inpatient Medicare beneficiary procedure; it was only a matter of time before CMS connected quality metrics with better care and smarter spending. Regardless of your metropolitan area and whether or not this gets approved, focusing on quality care is pivotal for future success.


Is your orthopedic service line prepared to deliver improved quality outcomes and greater patient satisfaction?


The overall structure of CJR is complex, but the key points include defined quality metrics, target prices based on blended hospital and regional spending and a retrospective annual reconciliation. For those 800+ hospitals the goal is to decrease costs while increasing quality – leading to healthier patients and communities.


This model forces hospitals and providers to comprehensively understand their entire total joint episode of care. Hospitals will need to address three critical success factors: care redesign implementation, data that can be measured and managed from, and the ability to align providers. These factors may seem within achievable on their own but we have found that sustainable results are achieved when all three are working together.


How Does This Focus Differ from our Current State?


Today hospitals primarily focus on activities occurring within their walls and feel a lack of control or impact to influence private physician practices, vendors and the variety of services contracted for the hospital. Outcomes vary even with the increase in outpatient services and physician alignment models.

Hospitals will be responsible for up to 90 days post discharge of the total joint episode. In addition, this does not just include elective lower extremity cases as traumatic hip fracture patients who are converted to a total hip replacement (DRG 469 or 470) will also be included in this bundle. Addressing this post-acute segment or total episode of care is often a challenge for hospitals to manage.


Care Redesign Calls for Process Change


Whether you are ready or not, change is necessary. At Stryker Performance Solutions our care redesign implementations transform traditional total joint service lines into a total joint program. We follow a 4A Methodology to assess, architect, assemble and assure helps identify variability and streamline workflow under this new bundled payment model Hospitals of all sizes can use this technique for a rapid cycle change.


4A’s Methodology


Assess: It will be imperative for hospitals to move from providing an orthopedic service of total joint replacement to a program that provides direction from the physician office through the entire episode including the post-acute discharge environment. . A complete assessment of the current state from physician and office, hospital workflow and education, and evaluation for appropriate discharge and follow up are the keys to developing your strategy. Understanding your data, both retrospective and concurrent is needed to understand your current gaps and will serve as the foundation for your care redesign plan.


Architect: After completing a thorough assessment hospitals will be able to identify gaps and create action plans to meet the CMS quality metric goals. This is very easy to put on paper; the challenge is determining what action(s) can have the biggest impact in the shortest timeframe. Hospitals across the United States have employed many measures to move HCAHPS scores with varied success rates and getting all team members engaged and onboard with change is never easy, especially as hospitals will be working to influence change pre -operatively at the physician practice level and within the post-acute space.


Assemble: Once hospitals have determined their required deliverables to meet CMS’ metrics, they will need to create a project plan and timeline that will hold them accountable to managing and completing the deliverables before the deadlines. The plan must address the needs of total joint patients from the initial decision for surgery through the 90 day post- acute phase. For some hospitals the necessary changes may be few, for others it will demand a much larger initiative to create a collaborative process among multidisciplinary teams.


Assure: To assure process improvement continues to happen, it’s imperative to foster a culture of ownership and accountability of the patients and their journey through each step. This may look different at each hospital – some will need to hire navigators and/or transition coordinators to monitor the qualified patients in the post-acute phase.


Total Integration


Overall it may be a small number of patients that fall into the qualified category of the proposed Medicare total joint bundle, but it is imperative that each hospital aligns itself to strive for the CMS target metrics. Making positive changes within your orthopedic service line will benefit all total joint patients and the providers who care for them.


Preoperative identification and education will be necessary from the physician offices, patient registration and preoperative departments. Setting consistent expectations with patients and families prior to surgery can lead to improved outcomes and the ability to return home. Hospitals in our database are achieving higher rates of discharge home through program implementation, resulting in a return to home after their 1- 2 day length of stay.


Due to short patient stays, it is imperative that postoperative education, discharge planning and preparation is coordinated across the continuum. to minimize patient and caregiver concerns and avoid readmissions. Coordination and collaboration with outpatient therapies, homecare, rehabilitative centers and skilled facilities will be necessary to as the Medicare reimbursement for the total joint episode of care will include all services rendered. In our experience, most hospitals do not consistently follow up in with the post-acute patient care since their reimbursement has not been tied to this part of the continuum.


Do you have the people, processes and system in place to handle this?

Understanding that all care providers will need to be involved whether the procedure is an elective joint replacement or an acute fracture that is fixed with a total joint is vital. Total integration and collaboration from the patient and family, the physician and hospital staff, and those external to the hospital providing services will help improve quality and overall outcomes. The shift from focusing only on the outcome of the procedure to the entire total joint episode will transform your service line into a total joint program This transition will help you to be successful under any type of value based payment models. Our subject matter experts and care redesign team helps you achieve these goals effectively and efficiently to meet the changing demands on your hospital and service line.

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Podcast

Featured Whitepapers