New Payment Models, New Opportunity for Growth

On April 1, 2016, the Centers for Medicare and Medicaid Services (CMS) rolled out the Comprehensive Care for Joint Replacement (CJR) model, in 67 different geographic areas, working with various healthcare partners throughout the nation.  This effort was tied to CMS’ recent efforts to look at innovative payment models, authorized by Congress through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), in order to reduce the nation’s ever increasing health care budget.  

pexels-photo-210590-min

How does CJR work?

Essentially, the roll out of CJR indicates a movement away from the traditional fee-for-service model that has dominated healthcare for the last few decades.  It is part of a larger effort to tie quality measure and patient satisfaction to how much providers are reimbursed for the care they provide.

Under the CJR, CMS estimates the cost for a joint replacement during a trial year and then reimburses providers at the target rate. At the end of the year, CMS then collects data on associated costs and quality measures and hospitals are either paid for good outcomes or forced to pay back costs for bad outcomes.

What does it mean for my practice?

CJR is currently still a pilot, but it indicates a changing paradigm in the healthcare industry.  As healthcare costs continue to rise to unsustainable levels, alternative payment models and fee structures are going to be the norm.  If the CJR trial is successful, it will become standard practice for joint replacement and could be used for other surgical procedures.

The CJR structure incentivizes good outcomes and involved care from providers.  This requires providers to step up their game, but also highlights the need to create partnerships with patients in order to create the best outcomes.

How is Epharmix solving the problem?

Unfortunately, the engagement necessary to maximize benefits is currently expensive and inefficient. Epharmix is using its expertise with patient engagement, as illustrated by success with EpxDiabetes and EpxCOPD, to help build better partnerships for patients and providers.

EpxSurgery is a suite of surgical apps that include EpxWound and EpxDecol.  These apps look to engage patients in their own healthcare and keep providers involved in care throughout the episode period.  EpxWound keeps patients aware of their wound healing and allows providers to catch surgical site infections earlier. EpxDecol keeps track of pateints adherence to pre-surgical care regimens.

Epharmix is committed to helpings providers and patients communicate in a way that maximizes the benefits of these new payment structures.  Helping patients actively manage their conditions improves outcomes and reduces expensive complications that can reduce quality and increase costs.  Make sure that your practice makes the most of the new Medicare payment system and provides the quality care that your patients deserve.

Editor’s Note: This post is written by Craig Yugawa, an independent researcher at EPX Research Center and a MD student at Washington University School of Medicine. Want to learn about how Epharmix can help with CJR payments in details? Drop us a note at team@epharmix.com.