Here are five insights:
1. There are two Diagnosis Related Group, or DRG, codes for lower extremity joint replacement — one for high-risk patients and another for low-risk patients.
2. But, when estimating risk, the Bundled Payments for Care Improvement Act and the Comprehensive Care for Joint Replacement rule lump both groups together, according to Dr. Kivlahan.
3. Treatment for low-risk patient could cost an average of $25,000. However, for high-risk patients, the costs could an average of $40,000 to $50,000 per episode of care.
4. Additionally, fracture patients typically have higher readmission and mortality rates than nonfracture patients.
5. While CMS updated the CJR and BPCI rules to reflect the difference in care required for facture versus nonfracture patients, Dr. Kivlahan said this issue is the “tip of the iceberg” for high-risk patients in new bundled payment models, reported MedPage Today.
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