On February 20, the Centers for Medicare & 医疗补助bet8娱乐(CMS)发布了一项拟议规则,将关节置换综合护理(CJR)模式延长三年,至2023年12月. CJR是一项捆绑支付计划,于2016年4月启动,目前计划于2020年12月结束. 该计划旨在鼓励医疗保健提供者之间的合作,以降低总体成本,提高90天髋关节和膝关节置换术期间的bet8娱乐质量.
In a sign that CMS recognizes that the program has 在保持高质量的同时,成功降低了成本曲线, the proposal includes the following highlights:
- 从第六年(2021年)增加到第八年(2023年)
- Includes outpatient knee and hip replacements
- Changes the CJR target price calculation
- Uses previous year instead of previous three years
- 删除国家更新和每年两次的费用表更新
- Removes anchor factors and weights
- Incorporates additional risk adjustment
- Changes high spend cap calculation
- Adds an episode-level risk adjustment beyond fracture status; target prices will be further adjusted at the episode level based on the beneficiary’s age and Hierarchical Condition Category
- 改变调解中适用于质量分数优秀和良好的参与者的质量折扣因子“以更好地识别高质量护理”
- Eliminates the 50% cap on gainsharing payments
For those hospitals and health systems affected by this 建议,下面是三个关键的策略,以纳入你的关节 replacement program.
1. Develop an outpatient joint replacement program
For years, 失去有利可图的住院关节置换术病例到门诊设置的威胁已经迫在眉睫. 最近决定将全膝关节和髋关节置换术从住院患者名单中删除,并允许医疗保险全关节患者在ASC环境中接受治疗, this has finally become a reality. Thus far, CJR has excluded outpatient total joints, despite the elimination of the two-midnight requirement. 医院一直在努力确定病人是否适合第二个午夜,并制定了一套混合流程,以确定谁适合住院,谁不适合作为门诊病人接受治疗. 建议将门诊髋关节和膝关节置换术纳入CJR项目, CMS通过消除必须确定患者是否包括在内的挑战,为医院提供了清晰度. Organizations without an effective outpatient joint 替代计划将在更现代的支付模式中挣扎, 从长远来看,可能会有在骨科中变得无关紧要的风险.
2. Identify internal cost savings (ICS) opportunities
Over the past four years, 成功的组织主要集中在降低急性后的成本,通过越来越多的病人出院回家,减少住院和亚急性康复的利用. Monitoring post-acute utilization and identifying further opportunities to reduce the episode spend remain important; however, 努力还应包括与外科bet8网站备用合作,以确定ICS的机会. CJR计划允许医院与bet8网站备用合作伙伴分享, and the savings calculation has the option to include ICS. However, 因为潜在的支付惩罚与整体的情景成本有关, 大多数医院都专注于减少急性期后的使用率. 虽然可能很少有机会从净支付对账支付储蓄中获益, 通过将ICS纳入收益分享协议,可能有重大机会降低直接成本并提高这些病例对医院的盈利能力. And with the proposed elimination of the gainsharing cap, 医院在设计这些安排时将有更大的灵活性.
这些努力不仅有助于您的联合项目,而且可能会在所有骨科手术中带来更广泛的节省机会, 与外科bet8网站备用建立更紧密的合作关系, and deeper alignment among the entire care team.
3. Continue to concentrate on post-acute cost savings
According to CMS, “changes in post-acute care use, suggesting shifts to less intensive sites of care, contributed the most to the decrease in episode payments.“成功的组织已经与急症后提供者建立了首选合作伙伴网络, transitioned from expensive post-acute rehab utilization, discharged more patients to home, 并开发了护理导航系统,以确保患者成功康复. Because of the lower cost, regional target prices have been driven down, 这使得医院更难以避免对CMS的还款处罚. In addition, 建议将目标价更改为上一年度将进一步降低目标价, 假设较近的时间段代表较低的偶发成本. 最后,虽然不是拟议规则的一部分,CMS考虑 changes to the target price calculation 通过在国家层面而不是地区层面制定价格.[
对于那些尚未专注于降低急性期后成本的组织来说,时间已经不多了. 20年前的传统护理途径在今天的付款人环境中将不再成功. 成功的话,可以避免另外三年的还款罚款, 医院必须围绕多学科护理团队组织起来,并确定进步的bet8网站备用领导,以制定策略,避免不必要的急性后成本.
Looking Ahead
考虑到行业的快速变化,执行一个成功的骨科bet8娱乐线战略是至关重要的. 由于CMS和其他支付者改变他们的支付方法和加速转移的情况下,门诊设置, 主动管理这种变化并发展您的bet8娱乐线将是非常重要的. Hospitals that delay will be left behind. Now is the time to act.
Published March 2, 2020