On July 9, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule describing its Comprehensive Care for Joint Replacement (CCJR) payment model, a pilot bundled payment program for major lower extremity joint replacements. While CMS’ increasing interest in bundled payments has been apparent, the announcement of this mandatory initiative was a surprise to many, given that the Bundled Payments for Care Improvement (BPCI) demonstration program is still in its early stages for many participants. In addition, CMS recently requested comments on the expansion of the BPCI program, which it states is not related to the CCJR pilot. Nonetheless, CCJR, which will be mandatory for about 1,200 hospitals, appears poised for implementation in January 2016. This article presents an overview of the CCJR program, highlighting its major components and comparing it to the BPCI program.  Obviously, we summarized and omitted some of the details of the 438-page CMS proposal, so...

What is the most cost-effective post-acute care setting for rehabilitation after a medical or surgical hospital stay—an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF)?  It is widely assumed that rehabilitative care in an IRF may be more effective because of its higher-intensity programs, lower lengths of stay, and fewer readmissions.  But, is this the full story?  Download this article

For 30 years, Medicare's hospital Inpatient Prospective Payment System has used DRGs to account--or risk adjust--for the differences in the cost of care for clinically complex patients.  By creating a direct link between reimbursement and outcomes, pay-for-performance adds a new layer to the issue of risk adjustment. Download this article

A new approach to data-driven decision making  Healthcare reform initiatives, driven by government, healthcare providers, and payers, are  shifting the focus of care delivery and payment from individual points of service to the whole patient and entire populations. This transition from “volume” to “value” (or population health) requires a mindset change for hospitals, health systems, and other providers. It necessitates an expanded perspective that encompasses the full spectrum of care for patient populations—from primary to post-acute services—to improve health and outcomes while reducing costs. Download Now

"Shock and awe" were words that many of our clients used when they received their Bundled Payments for Care Improvement (BPCI) "mock" reconciliation data from the Centers for Medicare and Medicaid Services (CMS) in early May. Some were dismayed at the significant reduction in financial surpluses from those that were expected, while others were alarmed by several apparent policy changes that have been implemented without notice and after contracts were signed. This article will discuss what we expected to see, what we actually saw, what we see as the consequent effects on reconciliation, and where we believe policy changes must be forthcoming. Download Now

By exploring the regional variations in Medicare payments for 90-day episodes of care (those beginning with a hospitalization that also includes post-acute care), this report provides key findings from an analysis on four different clinical episodes/areas of care: acute myocardial infarction, congestive heart failure, pneumonia and major hip and knee joint replacements. Download This White Paper

The Centers for Medicare and Medicaid Services (CMS) is allowing providers that are already participating in the BPCI program to evaluate expanding their participation to additional episode families. This article provides a structured approach to those providers for analyzing and evaluating new episode families for inclusion in BPCI. Download This White Paper