Joint Replacement Model an Opportunity for Home Care

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Amy Shellhart By Amy Shellhart 
Director of Product Management, Change Healthcare
Comprehensive Care for Joint Replacement Model

You can’t escape the fact that the Affordable Care Act and payment reforms continue to transform healthcare, for patients as well as providers. But I hope that you also haven’t escaped the realization that care and payment reforms present new opportunities for home care organizations.

One the latest opportunities is the April 1, 2016, start of the Comprehensive Care for Joint Replacement (CJR) model. According to 2014 data, more than 400,000 hip and knee replacements were performed on Medicare patients that cost more than $7 billion for hospitalizations alone.

In describing the program, the Centers for Medicare & Medicaid Services explains that complication rates vary by a factor of three among facilities while costs are more than double at some hospitals than at facilities. The model, implemented in 67 geographic areas, is an attempt to raise the quality of care while reining in the cost of that care from before surgery through the recovery period.

So what does this mean for your organization? If you are in one of the geographic areas covered by the CJR model, you should reach out to hospitals in your service area. The bundled payment that hospitals receive will extend beyond the walls of the facility to include post-acute providers such as home health.

Patrick Conway, CMS principal deputy administrator and chief medical officer, described it this way in a recent blog post: “We expect this incentive to coordinate the services a patient receives before, during, and after surgery will encourage hospitals and clinicians to partner with nursing facilities, home health agencies and other providers of rehabilitation services to provide seamless, high quality care.”

You already partner closely with physicians and other referral partners to provide patients with the home-based care that they need. And you should already be tracking clinical outcomes, whether for federal reporting purposes, to compare your internal performance over time, or to compare your performance with similar home care organizations.

Home care clinical software can give your organization the tools it needs to track patient progress and show your value to referring partners.

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