Joint Replacement Model (CJR) - WSHA Home Page · 4/5/2016 · CJR Quality Measures – PRO...
Transcript of Joint Replacement Model (CJR) - WSHA Home Page · 4/5/2016 · CJR Quality Measures – PRO...
Joint Replacement Model (CJR)
Jonathan Bennett, Senior Director, Decision SupportApril 5, 2016
1
Comprehensive Joint Replacement Program (CJR)• Program Overview
• Bundled Payments
• Data Models – DataGen
• Quality Reporting Requirements
2
CJR Overview• Start Date: April 1, 2016• Program Duration: 4 ¾ years• Frist Year: April 1, 2016 – December 31, 2016• MSAs: 67• MS-DRGs: 469 or 470
• Target prices will reflect the difference between elective procedures and those involving hip fractures
• Prices/payments: Includes IPPS operating & capital amounts
• Quality Performance: Composite quality score methodology
3
CJR Bundled PaymentsBundled Payments• Initial inpatient acute stay plus all covered services for
90 days post-discharge • Some exceptions for unrelated services/diagnoses • All providers continue to receive FFS payments • FFS payments are retrospectively reconciled to targets
Hospitals “Own the Bundles”• Excess of targets - risk• Below targets - reward• Quality metrics - must meet
4
CJR Target PricesSeparate Target Prices • MS-DRGs 469 and 470 with and without hip fractures• Based on three-years of historical data • Excludes payments/adjustments for IME, DSH, VBP,
Readmissions and HACs Discount Factor • Taken off the top to guarantee Medicare savings • Level of discount depends on quality performance score Blended Target • Transitions over time to 100% regional Rebasing • Baseline period will be updated every other year
5
CJR Estimated Performance Analysis
Case counts less than 11 are redacted per CMS data privacy rules6
Performance: DRG 470 without Hip Fracture
7
Performance: DRG 470 without Hip Fracture
8
DataGen Data Models • Review high-level reports
• Post acute care review
• Quality measures
• Drill-down reports are available from DataGen
9
CJR Quality Measures• Risk-standardized complication rate – NQF #1550• Patient experience surveys (HCAHPS) – NQF #0166• Patient reported outcome (PRO) data – functional
outcomes
10
CJR Quality Metric Analysis
11
CJR Quality Points Distribution
12
CJR Estimated Quality Metric Analysis
13
CJR Comparison Data: Quality Scores
14
CJR Quality Measures – PRO Measure• Patient reported outcome measure
• Patient’s perspective• Voluntary submission – “not really”
15
CJR Quality Measures – PRO MeasureThe data elements include:• 4 unique patient identifier(s) • 11 risk variables
Pre-operative data collection – must be completed between 90 to 0 days prior to the THA/TKA procedure.
Post-operative data collection – must be completed between 270 to 365 days after the THA/TKA procedure.
Data submission must occur within 60 days of the most recent performance period.
16
PRO Measure – Data Elements• Date of birth• Race and ethnicity• Date of admission• Date of THA/TKA
procedure• Medicare HIC Number• Body mass index
• PROMIS Global or VR-12• TKA - KOOS• THA - HOOS• Use of chronic narcotics
(≥90 days)• Total pain joint count• Quantified spinal pain• Health literacy
questionnaire
17
PRO Measure – Performance Periods• Model Year 2016
• Performance period: July 1, 2016 through August 31, 2016• Successful Requirements: Submit pre-operative data on
primary elective THA/TKA procedures for ≥50% of eligible procedures or a total of 50 procedures.
• Model Year 2017• Performance period: July 1, 2016 through August 31, 2016• Successful Requirements: Submit post-operative data on
primary elective THA/TKA procedures for ≥50% of eligible procedures or a total of 50 procedures.
18
PRO Measures – Data Collection• Who’s going to collect the data?
• Work flow• Patient coordination
• What method will the data be collected?• Internal• Vendor
• How will the data be reported?• Department coordination• CMS template
19
CJR Quality Data Timeline
20
Thank you
21
Additional ResourcesCMS contact information
• CJR questions can be emailed to [email protected]
CMS’ CJR website • https://innovation.cms.gov/initiatives/cjr
22