Comprehensive Care for Joint Replacement Model
Washington Hospital Healthcare System is participating in a New Care Improvement
Initiative from Medicare
Washington Hospital Healthcare System is participating in a Medicare initiative
called the Comprehensive Care for Joint Replacement (CJR) model. The CJR
model aims to promote quality and financial accountability for care surrounding
lower-extremity joint replacement (LEJR) procedures, commonly referred
to as hip and knee replacements and/or other major leg procedures. Washington
Hospital Healthcare System’s participation in the CJR model should
not restrict your access to care for your medical condition or your freedom
to choose your health care providers and services. All existing Medicare
beneficiary protections continue to be available to you. These include
the ability to report concerns of substandard care to Quality Improvement
Organizations and 1-800-MEDICARE.
The CJR model aims to help give you better care.
The CJR model aims to support better and more efficient care for beneficiaries
undergoing LEJR procedures. A CJR episode of care is typically defined
as an admission of an eligible Medicare beneficiary to a hospital participating
in the CJR model that eventually results in a discharge paid under Medicare
Severity-Diagnosis Related Groups (MS-DRG) 469 (major joint replacement
or reattachment of lower extremity with major complications or comorbidities)
or 470 (major joint replacement or reattachment of lower extremity without
major complications or comorbidities). The CJR episode of care continues
for 90 days following discharge. This model tests bundled payment and
quality measurement for an episode of care associated with LEJR procedures
to encourage hospitals, physicians, and post-acute care providers to work
together to improve the quality and coordination of care from the initial
hospitalization through recovery. Through this bundled payment model,
Washington Hospital Healthcare System will receive additional payments
if quality and spending performance are strong or, if not, potentially
have to repay Medicare for a portion of the spending for care surrounding
a lower extremity joint replacement procedure.
Medicare is using the CJR model to encourage Washington Hospital Healthcare
System to work more closely with your doctors and other health care providers
that help patients recover after discharge from the hospital, including
nursing homes (skilled nursing facilities), home health agencies, inpatient
rehabilitation facilities, and long-term care hospitals. The goal of the
model is to encourage these providers and suppliers to provide you with
better, more coordinated care during and following your hospital stay.
The model is expected to lower the cost of care to Medicare but your costs
for covered care will not increase due to these changes.
Washington Hospital Healthcare System is working closely with the doctors
and other health care providers and suppliers who will care for you during
and following your hospital stay and extending through the recovery period.
By working together, your health care providers and suppliers are planning
more efficient, high quality care as you undergo treatment.
Medicare will monitor your care to ensure you and others are receiving
high quality care.
Washington Hospital Healthcare System entered into financial arrangements
with collaborating health care providers and suppliers who are engaged
in care redesign with the hospital and who may furnish health care services
to you during your episode of care. Under these agreements, Washington
Hospital Healthcare System may share payments received from Medicare as
a result of reduced episode spending and hospital internal cost savings
with collaborating providers and suppliers. Washington Hospital Healthcare
System may also share financial accountability for increased episode spending
with collaborating providers and suppliers.
The following list includes health care providers and suppliers that have
established a collaborator agreement with Washington Hospital Healthcare
System in order to share in financial rewards and/or losses in the CJR model:
Dr. John Dearborn and Dr. Alexander Sah
2000 Mowry Ave., Fremont, CA 94538