Survey: Hospitals aren’t ready for Medicare bundled payment program

Hospitals may not be ready to handle the Centers for Medicare and Medicaid Services new bundle reimbursement payments for hip and knee replacement procedures, according to a report from Intralign.

In an online survey, Intralign said hopsitals reported an average grade of 55% out of 100% in rating their preparedness for CMS’s new Comprehensive Care for Joint Replacement datasets. 

Intralign reported that the biggest issues hospitals are facing are underdeveloped post acute care networks, poor internal information systems weak in modeling, tracking and reporting capabilities and undefined performance metrics.

The Centers for Medicare & Medicaid Services said its 5-year “Comprehensive Care for Joint Replacement” program would involve more than 800 hospitals in 75 geographic areas, bundling payments for hip and knee replacements from hospital admission to 90 days after discharge. The payment would cover “all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries,” the government health insurer said.

But reimbursements will be pegged to outcomes and costs, which allows Medicare to take back payments and reward good performance with additional payments.

The initial CMS CJR dataset will cover the 3-year baseline period from January 1, 2012 to December 31, 2014, and was initially used to model the program.  The data will be available to facilities so they can understand how CMS will view their facility in the program, Intralign said.

Though the initial 3 years will be the only data available initially, CMS will provide rolling data updates to hospitals on a quarterly basis. The data will allow hospitals to verify included episodes and address or contest issues, as well as monitor the status of their episode spend using the data, Intralign said.

The firm said that the data will come in 19 different raw files that require linking, episode mapping, validation and execution for analysis.  Intralign suggested that hospitals look into expanding their in-house analytics competencies in order to manage ongoing data analysis required by CJR.

The new program was announced last July, when Medicare proposed it would be bundling reimbursement payments for hip and knee replacement procedures, saying it wants to “hold hospitals accountable for the quality of care they deliver to Medicare fee-for-service beneficiaries.”

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