CJR is a payment model being tested for episodes of care related to total knee and total hip replacements (MS-DRG 469 and 470) under Medicare. One track of the CJR model qualifies as an Advanced APM under QPP. The model began April 1, 2016, and will run through December 31, 2020. CJR holds participant hospitals financially accountable for the quality and cost of an episode of care and incentivizes increased coordination among participating hospitals, physicians, and postacute care providers such as physical therapists. An episode of care begins with a patient’s hospital admission, continues upon hospital discharge, and ends 90 days postdischarge to cover the patient’s complete period of recovery.
As of February 1, 2018, about 465 hospitals in 67 metropolitan statistical areas are participating in CJR. Physical therapists in these areas may be impacted. Take a moment to learn about the model and determine if you should be thinking of marketing your practice to a CJR program.
Review CMS's overview of CJR.
Step 1: Understand CJR
Every Medicare total hip and total knee replacement procedure within the designated areas will be administered through CJR, including rehabilitation components of the episode of care. But even if you don't practice within a CJR area, similar models are sure to follow this lead, and there will be opportunities for physical therapist practices at large to be involved. Get a jump on the trend and use these resources to understand the implications of CJR and other bundled payment models.
Step 2: Determine if Becoming a CJR Collaborator Is Right for Your Practice
All total knee and total hip replacement procedures in the selected areas will be included under the CJR model. You can choose to actively become a collaborator under the CJR model or passively see these patients under your traditional payment structure. There are several details PTs need to consider before becoming a collaborator.
Step 3: Understand the Contracting Process
Becoming a collaborator in the CJR model will require contracting with a participating hospital(s). APTA has created a contracting toolkit that can be used in conjunction with APTA's managed care contracting toolkit that will help you identify important contracting considerations.
Step 4: Stay Up-to-Date on Clinical Practice Resources
Whether or not you're an active collaborator in a CJR bundle, delivering consistent evidence-based care, tracking your outcomes, and educating potential collaborating providers are keys to success in this practice model and in most other new payment models moving forward. Read more about evidence-based care and tracking outcomes data with the following resources:
Guide to Physical Therapist Practice
The Guide to Physical Therapist Practice (Guide) provides the description of physical therapist practice, which may be helpful in educating others on the role of physical therapy in collaborative care teams. Physical therapist intervention may result not only in more efficient and effective care, but also in more appropriate use of other members of the primary care team.
APTA's PTNow includes relevant evidence-based information to help with the management of patients with total joint replacements.
To extend the benefits of your treatment and help your patients improve or maintain their mobility and independence even after total joint replacement (TJR), the following evidence-based community programs emphasize physical activity and self-management to decrease the chance of readmission.
- Evidence-based community programs for arthritis management
Finding the right physical activity program can extend the benefits of your treatment and help your patients maintain their mobility and independence.
- Balance and falls information
Falls after TJR can lead to unplanned readmissions. It is important that you evaluate each patient's risk for falls.
- Physical therapy's role in reducing hospital readmissions
Physical therapists have expertise in providing recommendations for the most appropriate level of postacute care following surgery. You can make the case for being included in the health care team prior to and during care transitions to help in reducing hospital readmissions.
- Outcome measures
It is important to measure and report patient care outcomes within the relevant components of function to show best clinical practice to patients, providers, and payers.
- Telehealth information
Telehealth technologies may help with the recovery period after hip or knee replacement surgeries. Review APTA's guidelines on providing physical therapy using telehealth as well as issues to be aware of before you proceed.
APTA Statements, Summaries, and Comments
The following APTA summaries and comments to the federal government explain how the CJR model will affect the physical therapy community.
Questions regarding CJR should be sent to firstname.lastname@example.org.