Bundled Payment Models
Comprehensive Care for Joint Replacement Model (CJR)
CJR is a new payment model being tested for episodes of care related to total knee and total hip replacements under Medicare. The model began April 1, 2016, and is being tested in 67 metropolitan statistical areas for 5 years. Programs under the model will be administered by hospitals in the participating areas, and physical therapist practices will be impacted in those areas.
Proposed CJR Expansion and New Cardiac Care Bundle
The proposed 2017 Medicare physician fee schedule includes an expansion of CJR to include hip and femur fractures. It also introduces a mandatory bundling program for care associated with bypass surgery and heart attacks, including provisions that would incentivize the use of cardiac rehabilitation.
Bundled Payments for Care Improvement (BPCI) Initiative
BPCI is comprised of 4 broadly defined models of care, which link payments for the multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care.
How to Prepare
APM Contracting Checklist (.pdf)
You can choose to actively become a collaborator in an Alternative Payment Model or passively see these patients under your traditional payment structure. There are several details PTs need to consider before becoming a collaborator.
APM Contracting Guidelines (.pdf)
Becoming a collaborator in an APM will require contracting with a participating hospital(s). APTA has created an APM contracting guide that can be used in conjunction with APTA's managed care contracting toolkit to help you identify important contracting considerations.
FAQ: MACRA and Alternative Payment Models (.pdf)
The Medicare Access and CHIP Reauthorization Act (MACRA) offers providers a unique mechanism to meet quality improvement benchmarks and receive incentive payments by forming Advanced Alternative Payment Models (Advanced APMs). These models will be structured to mirror the MIPS quality measures, while serving a unique patient population with efficient and high quality care. These "Frequently Asked Questions" can help you learn more about Advanced APMs and the financial incentives for participants. The document will be updated periodically as more information becomes available from CMS.
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Fact Sheets and Summaries