CMS makes it compulsory for hospitals to take part in the bundled-payment program for the procedures of total hip and knee replacement on Medicare beneficiaries. Since CMS made all the hospitals in the country’s 67 markets to switch to value-based payment program as part of its 5-year demonstration; surgeons and organizers of hospitals found it really controversial.
The Republicans in Congress showed aggression towards the Comprehensive Care for Joint Replacement and named it as a governmental intrusion in medical practice. The vice president for orthopedics and neuroscience at Community Health Network, Jhon Fohrer perceived this bundled-payment program as a governmental project demanding a lot of time and resources that they do not possess. Fohrer controls 3 hospitals that offer joint replacements. in the Indianapolis market.
Dramatically, the opinions of other hospital’s surgeons and leaders contradicted to Fohrer’s views. Rendering to the new data of CMS, a large number of hospitals successfully fulfilled the exigent requirements of this program due to which they procured monetary incentives. In the light of this program, hospitals get a fixed amount of money in return for the overall services they delivered to the patients of joint replacement from the day of their admission till three months. However, it will not include any additional reimbursements for complications, post-acute services or for readmissions.
Rendering to the CMS data observed by Modern Healthcare, almost ½ of the participants obtained gain-sharing payments for fulfilling the goals of cost and quality of the bundled-payment program.
The total of quality bonuses and gain-sharing payments turned out to be $37.6 million for the 33,152 episodes of care of joint-replacement of under the CJR program. This rate exceeded to $11 million. Also, the normal bonus payments of per 3 months episodes of care came out to be $1,134. In addition, the range of payments of individual hospitals for each episode of care was in the middle of $14 to $3,591 million.
These amounts of payments exhibited just a fraction of the savings that three hundred and eighty-two hospitals acquired whereas the Medicare bagged the rest of the amount.
The influential outcomes in the 1st year gave rise to the August proposal of the Trump government to rationalize the program. Rendering to the opinion of some policymakers and hospital administrators, the movement of quality enhancement and reduced cost will get slower if this program will be offered as an option to 33 out of the 67 market across the country. According to the estimation of CMS, Medicare will be charged almost $90 million as a result of this transformation in cost reductions in the upcoming 3 years. This program is favorable for the patients since it delivers quality care to them. Offering it as an option implies to the right of decision to the public when they find it no longer fruitful for them.
In the Indianapolis region, the two hospitals from Community Health Network received quality bonuses of nearly $193,000 million for one hundred and fifty-five episodes of care of joint replacement. The quality score that these two hospitals gained was an excellent (for one facility) and good (for the other facility). The 3rd facility of the same community network is on its way to acquiring higher quality scores.
Two of the country’s large hospital systems, Catholic Health Initiatives, and Sutter Health are still making up their mind whether to be in the race or to leave this program. Safety-net hospitals stepped forward in a conflict that they provide quality and costly care to the sicker thus, have more challenging tasks to fulfill the patient’s requirements. Some of the surgeons in Seattle are still pondering to go for the optional CJR program or refute it.