For the first time, CMS is making bundled payments mandatory for hospitals, specifically for THA/TKA patients. This program, set to begin on April 1, 2016, takes the first generation of bundled payment programs to a new level by holding hospitals accountable for not only costs, but also complication rates, quality of care, and patient experiences.

1. CONFIDENTIAL | 1CONFIDENTIAL | 1CONFIDENTIAL | 1CONFIDENTIAL | 1
Comprehensive Care for Joint Replacement (CJR)
What this mandatory bundled payment initiative means for hospitals
Published March 2016

2. CONFIDENTIAL | 2CONFIDENTIAL | 2
Comprehensive Care for Joint Replacement (CJR)
CMS is making bundled payments mandatory for hospitals, specifically for THA/TKA
patients. This program, set to begin on April 1, 2016, takes the first generation of bundled
payments to a new level by holding hospitals accountable for costs, complication rates,
quality of care, and patient experiences.
 Enhance quality of care
 Improve outcomes and reduce readmissions
 Better overall experiences for orthopedic surgery
patients
 Coordinate care across the hospital and post-discharge
environment

3. CONFIDENTIAL | 3CONFIDENTIAL | 3
The Situation Today
in annual spending on hip and knee
replacements and associated care
With hospitals providing vastly different levels of care, the spending of federal
dollars has not been cost-effective and does not adequately promote patient and
population health.
Patients receive care from many providers, without proper coordination of care
plans and instructions. This lack of consistency can lead to re-hospitalizations
and complications.
$7
billion
Federal Spending

4. CONFIDENTIAL | 4CONFIDENTIAL | 4
Goal of CJR
These hospitals will be financially accountable for an entire care “episode” - the
patient’s procedure, as well as up to 90 days of post-discharge care.
If the total episode cost falls below the target price, CMS reimburses the hospital
the difference as a bonus. Hospitals forgo this bonus if they do not maintain good
HCAHPS scores or if they experience high rates of hip/knee surgery complications
or readmissions.
for approximately 800 hospitals
in 67 geographic regions
CJR is MANDATORY
Care Coordination

5. CONFIDENTIAL | 5CONFIDENTIAL | 5
Achieving the Goals of CJR
By deploying CipherHealth’s integrated solution, View, for care management and patient
outreach, hospitals can efficiently engage with physicians, home health agencies, skilled
nursing facilities, and other providers to coordinate care for beneficiaries.
View is fully customizable to help you successfully implement the CJR model

6. CONFIDENTIAL | 6CONFIDENTIAL | 6
More about CipherHealth Technology
+
PATIENT VISIT PRE/POST VISIT
Care Coordination and Patient Engagement on One Integrated
Platform
Contact PopHealth@CipherHealth.com to request more information

7. CONFIDENTIAL | 7CONFIDENTIAL | 7
About the author
Catherine Moser
Vice President, Population Health Solutions
CipherHealth
555 8th Avenue, Suite 701
New York, NY 10018
(520) 271-7610 | cmoser@cipherhealth.com