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Prepare for Shifting CMS Reimbursement

In early 2015, the Department of Health and Human Services (HHS) announced intentions to shift a significant portion of Medicare reimbursement to alternative payment models.

HHS set goals to shift 50% of Medicare fee-for-service payments to alternative models and link 90% of traditional Medicare payments to quality or value by 2018.

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Webinar Overview

This webinar explores the Comprehensive Care for Joint Replacement (CJR) Model, a CMS requirement for retrospective bundled episode reimbursement for hip and knee surgeries. Under this pilot program, CMS plans to monitor the total cost of care for MS-DRGs 469 and 470, including post-acute care 90 days after discharge. CMS plans to compare the total cost of care to predetermined target prices annually and either collect repayment or provide reconciliation. The webinar provides an overview of the model and discusses initial steps in minimizing potential effects.

After viewing the webinar, you will be able to:

  • Gain a general understanding regarding the intended purpose and operation of the CJR Model
  • Determine potential methods to monitor the total cost of care for affected MS-DRGs in order to predict whether an organization will be able to remain within target costs set by CMS
  • Recognize the benefits of increased coordination of care with downstream healthcare providers to potentially prevent the total cost of care from exceeding target costs set by CMS