CJR Simplified. A Practical Guide to Understanding & Preparing for CJR

Need to keep up with CJR?

The basic idea behind Comprehensive Care for Joint Replacement (CJR) is that Medicare will begin paying hospitals based on a ‘target price’ for joint replacement services. If an episode’s actual cost is greater than the set target price, the hospital is required to make a reconciliation payment to CMS. Hospitals also have the ability to earn a financial reward if you come in under the target price.

Naturally, writing a check to Medicare at the end of the year is not something any hospital is interested in doing, so understanding how the system works is a must & exactly what you’ll get by reviewing this guide.

In this guide you’ll learn:

• 5 key points to remember;
• Who is affected by CJR;
• How composite scores are calculated;
• How hospitals are ranked;
• How submitting PROs impacts your ranking; and
• How submitting PROs impacts target price and whether you get reimbursed, or are paying CMS at the end of the year

There are many variables that come into play, which makes predicting outcomes and your quality score a challenging task. There is, however, one thing that hospitals can do right away that can guarantee an improvement to your score, and that is submitting PRO data. Think of it like extra credit, just for showing up.