Bundled Payment

March 4-March 8: Safety-Net Hospitals Underperform in CJR

February 12, 2021 5:17 pm

Feb. 28—As Medicare considers the launch of additional mandatory payment models in the coming months, new research reports that safety-net hospitals underperformed other participants in the first mandatory Medicare bundled payment model.

The Comprehensive Care for Joint Replacement (CJR) model was launched April 1, 2016, to establish bundled payments for Medicare beneficiaries undergoing hip and knee replacements. Under CJR, hospitals receive bonuses or pay penalties based on Medicare spending per hip- or knee-replacement episode. In its first year, participation was mandatory for most hospitals in 67 randomly selected metropolitan statistical areas.

Advocates for hospitals with large shares of low-income patients warned that they would have difficulty participating in such a model. And new research indicates they may have been correct.

new study in Health Affairs used Medicare data to evaluate the performance of 792 hospitals in the first year of CJR and found 42 percent fewer safety-net hospitals qualified for bonus payments based on quality and spending results, compared with other hospitals. (Specifically, 33 percent of safety-net hospitals qualified, compared with 57 percent of other hospitals).

Additionally, safety-net hospitals’ financial rewards per episode were 39 percent less ($456 compared with $743) than the bonuses for other hospital types.

“Continuation of this performance trend could place safety-net hospitals at increased risk of penalties in future years,” the authors wrote.

The Health Affairs authors urged strategies by Medicare, such as those that reward high-quality care for vulnerable patients, to enable safety-net hospitals to participate effectively in CJR.

The recent findings followed a warning by some about disproportionate impacts of CJR due to its lack of a socioeconomic adjustment.

“Socioeconomic status can substantially affect patients’ capacity to recover at home and thus the cost of rehabilitation following surgery during the 90-day CJR episode,” Said A. Ibrahim, MD, MPH, University of Pennsylvania Perelman School of Medicine, and other researchers wrote in a JAMA commentary.

The new safety-net findings also followed earlier positive overall reports on the program, which CMS is considering whether to expand nationwide. For instance, a study in the January issue of the New England Journal of Medicine concluded that in the first two years of CJR, there was a modest reduction in spending per hip- or knee-replacement episode, without an increase in rates of complications.

A January Health Affairs study found hospitals in the CJR model had a larger decrease in spending per joint-replacement episode than those in a control group of hospitals.

Earlier Concerns

America’s Essential Hospitals (AEH), which represents 325 safety-net hospitals, warned CMS in a 2017 letter that the quality measures chosen for the CJR model lacked risk adjustments for factors outside the hospitals’ control.

Caring for lower-income patient populations leaves such hospitals with higher shares of uncompensated care than other types of hospitals, with nearly 75 percent of their patients receiving Medicare or Medicaid coverage.

Essential hospitals participating in the CJR model are disproportionately disadvantaged based on the quality metrics used to evaluate performance and calculate reconciliation payments, AEH stated.

AEH hospitals included in CJR reported problems affording needed technology upgrades, process redesigns, personnel changes, care coordination, expanded quality measurement, risk management, network development, governance, and legal restructuring.

AEH had urged CMS to cancel mandatory participation in any of its payment models.

Monday, March 4

Deadline for skilled nursing facilities to review provider preview reports for accuracy prior to the April 2019 Nursing Home Compare site refresh. Learn more.

28th National HIPAA Summit in Washington, D.C. (through March 6). Learn more.

Planned release of information blocking rules by CMS and the Office of the National Coordinator for Health IT, according to an HHS announcement on Twitter. Responses will be accepted until May 3.

Deadline to submit comments on the Department of Veterans Affairs’ proposed rule implementing urgent care provisions of the MISSION Act of 2018. Learn more.

American College of Healthcare Executives’ 2019 Congress on Healthcare Leadership in Chicago (through March 7). Learn more.

Deadline for rural hospitals and other eligible providers to apply for $21 million in Health Resources and Services Administration grants to expand the physician workforce in rural areas. Learn more.

Tuesday, March 5

Webinar by HFMA titled “Protect Your Revenue by Tackling Uncompensated Care.” Learn more.

Early-registration deadline for the HFMA Annual Conference. Learn more.

Listening session by CMS on the Interoperability and Patient Access proposed rule. Learn more.

Webinar by the Joint Commission titled “Pioneers in Quality™ eCQM Expert to Expert Webinar Series: CAC 3 and EHDI-1a eCQMs.” Learn more.

Webcast and briefing by Health Affairs in Washington, D.C., titled “Patients as Consumers.” Learn more.

Hearing by the Senate Health, Education, Labor and Pensions Committee titled “Vaccines Save Lives: What Is Driving Preventable Disease Outbreaks?” Learn more.

Webinar by CMS for staff of Medicare-Medicaid plans (MMPs), Dual-Eligible Special Needs Plans (D-SNPs), and PACE organizations titled “Recruiting Members and Supporting Participation in Plan Governance.” Learn more.

Wednesday, March 6

Hearing by the Senate Finance Committee titled “Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes.” Learn more.

Hearing by the House Energy and Commerce Committee’s Health Subcommittee titled “Strengthening Our Health Care System: Legislation to Lower Consumer Costs and Expand Access.” Learn more.

Hearing by the House Oversight and Government Reform Committee titled “GAO’s 2019 High-Risk Report.” Learn more.

Webinar sponsored by AHIP titled “Right Data, Right Time: A 360-Degree View on Health & Wellness.” Learn more.

Hearing by the Senate Special Committee on Aging titled “The Complex Web of Prescription Drug Prices, Part I: Patients Struggling with Rising Costs.” Learn more.

Thursday, March 7

Hearing by the Senate Special Committee on Aging titled “The Complex Web of Prescription Drug Prices, Part II: Untangling the Web and Paths Forward.” Learn more.

Hearing by the House Ways and Means Committee’s Health Subcommittee titled “Promoting Competition to Lower Medicare Drug Prices.” Learn more.

Webinar sponsored by America’s Health Insurance Plans titled “Dramatically Improve Your Plan’s Medical Records Review ROI.” Learn more.

Meeting sponsored by the American Journal of Managed Care titled “Advancing Quality Oncology Care in the Evolving Value-Based Care Landscape” in Dallas. Learn more.

Webinar hosted by Lumere titled “Leveraging Physician Partnerships in Reducing Variation – A Conversation with Geisinger Health System.” Learn more.

Public meeting of the Medicare Payment Advisory Commission in Washington, D.C (through March 8). Learn more.

American Medical Student Association’s Annual Convention & Exposition in Washington, D.C. (through March 10). Learn more.


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