Welcome Medicare Nation!
Hot Topic – The Comprehensive Care For Joint Replacement Model
(CJR Model)

Hip Replacements & Knee Replacements are the MOST COMMON
Inpatient Surgery for Medicare Beneficiaries.
In 2014 over 400K procedures were done, which cost Medicare
over 7 Billion $ for the Hospitalization for these
procedures ALONE.
Hip & Knee Replacement Surgeries can require long recovery
time & long Rehab periods.

I KNOW!  I’m not even on Medicare yet, and I’ve had TWO
Arthroscopic Knee Surgeries, and each surgery took me about a good
6 MONTHS to recover.
 
This is the SCARY PART!  
The Quality & Care you receive VARIES from one Hospital to
the next!
Complications like –

Infections received at the hospital …….OR
Implant Failures

Can be 3X Higher Performed at Some Hospitals More Than Other
Hospitals.
To me……that is just NEGLIGENCE! 
When you go into a hospital……you expect to receive the best
care, a clean environment and YOU SHOULD NOT  CONTRACT 
ANY INFECTION OR DISEASE from the Hospital you’re
being treated at!  That’s what you Expect from a
Hospital…..NOTHING LESS. But……it is apparently going on RIGHT NOW
Nation!
And it takes a CMS LAW or MODEL PROGAM to prevent it from
happening in EVERY Hospital? Aye,,yi,,,yi.
 
WHY IS THIS HAPPENING TO YOU?
In episode 34 on Medicare Nation, you listened to Melissa’s
Story.
Melissa’s story is about the struggles she had with her mother,
who suffered a broken hip and the FRAGMENTED care her mom received
while in the hospital and the struggles she had in moving her mom
to a skilled care facility and then setting up home care physical
therapy for her mom.
That is why all this is happening Nation!
There is a LACK OF COMMUNICATION, between Hospital Staff, other
Doctor’s, Skilled Nursing Facilities and Home Care Physical
Therapy.
NO ONE is talking to anyone else! The LINKS in the CHAIN of
Patient Care is BROKEN, and YOU are paying for it! 
This FRAGMENTATION of Care is causing LONGER RECOVERY TIMES,
HIGHER HOSPITAL RE-ADMISSIONS & HIGHER OUT OF POCKET COSTS FOR
YOU & FOR MEDICARE.
The Comp Care Joint Replace Model Addresses the LOW QUaLITY CARE
& Higher Costs that come from this FRAGMENTED CARE, by –
PROMOTING CO-ORDINATED PATIENT CENTERED
CARE!
Imagine that Nation!  Putting the Patient 1st!
What a New Concept!
 
HOW  WILL  THE  CJR  MODEL 
WORK?
Started  April 1,  2016

The hospital in which the hip or knee replacement and/or other
major 

leg procedure takes place, will be accountable for the
costs and quality of related care  from the time of the
surgery through 90 days after hospital
discharge—what is called an   “episode” of
care.

Depending on the hospital’s quality and cost performance during
the 

episode, the hospital will either 

Earn a financial reward    
OR, 
beginning with the second performance year, be required
to repay Medicare for a portion of the
spending. 
This payment structure gives hospitals an
incentive to work with 


physicians, 
home health agencies, 
skilled nursing facilities, 
and other providers to make sure beneficiaries receive
the coordinated care they need 

The goal is reducing avoidable hospitalizations
and complications. 
Hospitals in the model will be provided access to additional
tools – such as spending and utilization data and sharing of best
practices -- to improve the effectiveness of care coordination. The
model also gives providers additional flexibilities that are not
otherwise available under Medicare so they can better manage the
care of patients, including patients who are at home.
By “bundling” payments for an episode of care,
hospitals, physicians, and other providers have an incentive to
work together to deliver more effective and efficient care.
The CJR model is being tested in 67 geographic areas throughout
the country, and nearly ALL hospitals in those
geographic areas are required to participate.
The CJR model supports Health & Human  Service’s 
efforts to transform the health care system towards one focused on
better quality care, sm