3 Stars or Better Critical for CCJR Model

On July 9, 2015, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule on the Comprehensive Care for Joint Replacement (CCJR) demonstration model. The CCJR model is a five-year demonstration project that would test bundled payments for lower extremity joint replacements (LEJR). The model will only apply to elective LEJR procedures provided by Inpatient Prospective Payment System (IPPS) hospitals in the 75 selected metropolitan statistical areas (MSA). When finalized by CMS, the CCJR model will be implemented January 1, 2016.  To read more about the CCJR project go to http://innovation.cms.gov/initiatives/ccjr/.

A key component or benefit of participating in the CCJR project is the ability to waive the 3 day qualifying stay requirement. But as BKD points out this only plays out if receiving SNFs are a 3 Star or better center on CMS 5 Star Rating system. “The waiver is only valid if the beneficiary is transferred to a SNF with a three-star or higher rating on the CMS Nursing Home Compare website. Beneficiaries still would retain their right to choose the SNF, but if the SNF is not rated at least three stars, the use of the three-day stay waiver is not available. As a result, hospitals will be looking for PAC partners, especially SNFs, to which they can discharge patients more quickly than today.”

BKD goes on to offer some tips to assist your center in achieving 3 Stars or better:

  • Evaluate needed changes to increase your rating on Nursing Home Compare and be prepared to share those changes with potential hospital partners.
  • If you’re unable to increase your rating prior to the program’s inception, be prepared to share information about your quality and cost to care for LEJR patients.
  • Identify other specialties to supplement your skilled program volume, as hospitals may be reluctant to refer LEJR cases to lower-rated facilities.

To visit CMS Nursing Home Compare go to https://www.medicare.gov/nursinghomecompare/search.html.

To read more about CMS 5 Star Rating System go to

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS.html

To read more about this BKD article on the CCJR project got to

http://www.bkd.com/articles/2015/snf-impact-of-joint-replacement-bundled-payments.htm?mkt_tok=3RkMMJWWfF9wsRojvanMZKXonjHpfsX67%2B4vUK%2BxlMI%2F0ER3fOvrPUfGjI4FTcZiI%2BSLDwEYGJlv6SgFT7nDMaxwy7gIWxQ%3D

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