How will the CCJR bundled payment system effect you?

By Susan Saldibar

If you are a Skilled Nursing provider, you know (you do know right?) that as of January there is a new bundled payment mandate called “The Comprehensive Care for Joint Replacement (or CCJR) Bundled Payment system.”

Announced this past July, the new payment model creates a new set of quality and process standards that impact hospitals and all providers of rehabilitation care and services. There is a lot packed into the CCJR program, and you don’t need to know it all, except where it impacts you — and it will impact skilled nursing as well as acute care providers and other post-acute care providers.

I spoke with Mark Besch, Vice President of Clinical Operations for Aegis Therapy, a Senior Housing Forum Partner, about what they are doing to help skilled nursing facilities get ready for CCJR in order to leverage the program to the benefit of their residents and their organization.

The Details

First, Mark shared a few facts with us:

  • The proposed new rule was announced in July, 2015.
  • It is a 5-year program that will apply to all acute care hospitals.
  • Implementation is currently scheduled to begin in January, 2016.
  • There are 75 selected metropolitan service areas (MSAs) that will initially be impacted. (Further down in the article we will tell you how to access this list.)
  • With the exception of existing bundled payment models, participation will be mandatory.
  • The “bundle” includes the cost of the acute hospital admission plus all Medicare costs for 90 days after discharge (called an “episode”).
  • Hospitals will bear financial responsibility for the cost of the episode as compared to their target price. They can share in savings, or may have to repay Medicare if their costs exceed the target rate.

How can you make CCJR work to your advantage?

First, find out if you (or the hospitals who refer to you) are in one of the 75 metropolitan areas within the U.S. targeted for mandatory participation. Assuming that you are, the next step is to understand what your referring hospitals’ guidelines are and what processes and quality measurements impact your skilled nursing organization.

Because so much of CCJR revolves around improving the processes surrounding TJR, follow up therapy is key and you’ll want to identify a strong therapy partner. “You will need someone who understands CCJR and knows how to make it work to your advantage,” says Mark.

Why? Several reasons. Two key success factors will be managing the SNF length of stay and helping to avoid hospital readmissions (they make up the largest components of the episode costs). There are techniques and methods used by seasoned professionals that can help reduce the instance of re-admissions through established processes and high quality transitional care, which will facilitate a smoother transition. And, since tracking will be more important than ever, IT experience is needed to produce reports that can accurately track performance and adherence.

Therapy providers, such as Aegis, understand how CCJR works and how they can help skilled nursing care providers take advantage of CCJR. Here’s what you want in a therapy provider:

  • Nationally recognized in the marketplace

  • Thorough understanding of CCJR and value-based purchasing

  • Expertise and resources to provide high quality outcomes

  • High volume of quality outcomes

“It’s time to get in position to benefit from the new CCJR bundled payment system,” says Mark. He added, “And, regardless of who you select, make sure your partner knows how it works, has a proven track record, and the experience to leverage with acute care providers in the marketplace.”