Welcome Medicare Nation!

Hot Topic – The Comprehensive Care For Joint Replacement Model (CJR Model)

1. Hip Replacements & Knee Replacements are the MOST COMMON Inpatient Surgery for Medicare Beneficiaries.
2. In 2014 over 400K procedures were done, which cost Medicare over 7 Billion $ for the Hospitalization for these procedures ALONE.
3. 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 –

1. Infections received at the hospital …….OR
2. 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

1. 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.

1. Depending on the hospital's quality and cost performance during the 

episode, the hospital will either 

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

1. physicians, 
2. home health agencies, 
3. skilled nursing facilities, 
4. 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, smarter spending, and healthier people through care transformation and payment reform.

WHAT  AREAS  ARE  PARTICIPATING  IN  THE  CCJR  MODEL

Over 800 Hospitals across the US are participating, in 67 Geographical Locations.

Areas were determined based on statistical population data, with populations of over 50K residents.

Here are a Few selected Areas:

1. Florida – Broward, Collier County, Gainsville, Hernando, Hillsborough, Indian River County, Lake County, Martin, Miami-Dade, Orange County, Osceola, Palm County, Pensicola area, Pinellas, Pasco, Santa Rosa County, Seminole County and St. Lucia County

 

1. California – Alemeda County, Contra Costa County, Los Angeles County, Marin County, Orange County, San Francisco County, San Mateo, Stanislaus County, 

 

The rest are on the CMS.gov site. Search "CJR Model Geographical Areas," To find out if a Hospital or County where you reside is participating.

OR

You can go to my website, www.callsamm.com  and I'll put up a PDF of the Counties participating in the CJR Model program for you to request.

 

 

You can also download a copy of the Federal Register, which is a daily journal of the US Government.  The FINAL Rule for the CCJR Model is there in LONG Form

https://goo.gl/hN44cm

Federal Register/ Vol. 80, No. 226 / Tuesday, November 24, 2015 / Rules and Regulations 

www.callsamm.com - has all of this information available for you.

 

Do you have questions or feedback? I'd love to hear it!

I may answer one of your questions on the air!

email me:

[email protected]

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Find out more information about Medicare on Diane Daniel's website!

www.CallSamm.com