Properly redesigning care to ensure optimal patient outcomes will top the agenda of newly forming CJR teams that will be working hand-in-hand with orthopedic surgeons to set the strategy, monitor progress and nimbly respond to new performance improvement opportunities.
If you’re in region affected by the Comprehensive Care for Joint Replacement (CJR) bundled-payment program of the Centers for Medicare & Medicaid Services (CMS), it’s a given that you’ll need to assemble a team to address gaps in care design—if you haven’t done so already.
Precisely who comprises this team will look different from place to place, depending on facility type, size and staffing conventions. Almost certainly it will include a member representing the C-suite (likely the CFO), clinical quality (e.g., CMO, CNO, VP of quality or service line leader) and supply chain (director- or VP-level) and probably also someone in patient services. The team would ideally also include members focused on post-acute care and care navigation (through discharge and perhaps beyond), as well as the legalities surrounding CJR-related gainsharing and reporting requirements.
Orthopedic surgeons, as captains of the ship throughout the episode of care, also quickly become integral to the team since they affect, and are affected by, all major elements of CJR—including the cost of devices and associated products that get used, length of hospital stays, and quality of care and patient outcomes.
By far the team’s biggest task overall is to redesign care to ensure total joint patients receive the best possible care to end up with optimal outcomes. That means introducing a level of standardization and efficiency to the way patients are managed in terms of care protocols and variation reduction, education (e.g., joint camp and family participation requirement), surgery and recovery expectations (“How long before I can return to work?” “What will my pain be like?”), and how patients get tracked once they’re discharged to home or a skilled nursing facility.
The workflow of an impactful CJR team will be determined by two MapQuest-like questions: Where are we now and what’s our destination? It helps to think of the journey as a series of steps:
- Situation assessment. You’ll need both a “scorecard” of your hospital’s current cost and quality performance (as measured by CMS) and what’s driving those outcomes. If CJR went live today, would you qualify for a reconciliation payment or be facing a penalty?
- Care redesign. A gap analysis will unveil possible directions forward on care pathways and protocols, patient engagement, key performance indicators and alignment with post-acute providers.
- Physician engagement. Doctors will get involved in implementing the care redesign strategy if they helped craft the vison for what that will look like. Keep them engaged via education sessions, transparency with performance data and regularly reviewing opportunities for improvement.
- Monitoring and adjustment. CMS will be resetting your target price several times, ultimately basing it wholly on your performance vis-à-vis other providers in your region, so you’ll want to continually evaluate where you’re at relative to that moving bullseye. Tactics such as gainsharing that initially appeared to be a good first move might later pale in comparison to other means to drive physician behavior (e.g., investing in upgrades to the orthopedic unit). Similarly, you might find it makes more sense to shift cost-cutting efforts from the acute to the 90-day, post-discharge portion of care episodes.
It’s likely that the most significant saving opportunities will be found on the post-acute side, where many important relationships have yet to be built. It’s also probable that all hospitals will need to supplement their internal capabilities one way or another. Smaller facilities will need the most help benchmarking their quality and tracking patients through the post-acute phase of care. Most hospitals will need assistance in automating the way patient-reported outcomes (PROs) get collected. And large, geographically dispersed systems may need the consultative support of experienced physician leaders for care redesign activities.
A properly assembled, mission-driven CJR team will reap a long list of benefits for sponsoring hospitals, including lower episode costs, higher care quality, better HCAHCP scores, and improved satisfaction for patients, families and caregivers. By collecting new types of outcomes data, a CJR team can expand on joint registries to start drawing more meaningful correlations between product use and patient results. All that focus on quality will in turn attract the most desirable physicians, and patients steered in their direction by large employers and commercial payers that share CMS’ passion for change.
HealthTrust has an entire library of videos addressing the most frequently asked questions about CJR, including what constitutes a “bundle” and when and how to collect PROs. To learn more about HealthTrust’s CJR solution, contact Doug Jones.