Payment Reform: What does it actually mean?

Payment reform is back on center stage. And after several voluntary pilot programs, it has taken a big step forward with a new initiative mandated by CMS. This program goes into effect April 1, 2016 and signals a seismic shift toward value-based-payments. But first, some quick context: The Comprehensive Care for Joint Replacement (CJR) program…

Payment reform is back on center stage.

And after several voluntary pilot programs, it has taken a big step forward with a new initiative mandated by CMS. This program goes into effect April 1, 2016 and signals a seismic shift toward value-based-payments.

 

But first, some quick context:
The Comprehensive Care for Joint Replacement (CJR) program is the first mandatory bundled payment program introduced by the Centers for Medicare and Medicaid Services (CMS) aimed to reduce cost and enhance quality across hip and knee replacement procedures.

This is what an overview of the program looks like:

CJR

 

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How does it work?
Acute care hospitals across 67 markets will be held accountable for all expenditures related to a lower extremity joint replacement from admission through ninety-days post-discharge.

 

CMS will measure total spend as compared to a target price established based on hospital-specific and regional historical data. Under CJR, reimbursement will also be linked to quality of care and overall patient satisfaction.

 

For a hospital to be successful in a bundled payment model, alignment with physicians, post-acute care providers, and other collaborators is key. CMS and the Office of of the Inspector General (OIG) have issued fraud and abuse waivers to open the door for gainsharing between hospitals and CJR collaborators to facilitate this alignment.

 

Before it goes live on April 1, 2016, hospitals should take steps to understand current cost and quality performance, strengthen physician relationships, and explore tools and technologies to aid in care coordination – all of which will be critical for success under CJR and bundled payment programs to come.


InVivoLink Announces John Bass as CEO

Posted on January 6, 2016 by HealthTrust NASHVILLE, Tennessee—January 6, 2016—InVivoLink announces the appointment of John Bass as its chief executive officer (CEO). The healthcare technology company, a HealthTrust℠ affiliate since November 2014, provides expertise in bundled payments and value-based medicine that complements HealthTrust’s medical device sourcing and consulting capabilities. Bass has served as COO of…

NASHVILLE, Tennessee—January 6, 2016—InVivoLink announces the appointment of John Bass as its chief executive officer (CEO). The healthcare technology company, a HealthTrust℠ affiliate since November 2014, provides expertise in bundled payments and value-based medicine that complements HealthTrust’s medical device sourcing and consulting capabilities.

Bass has served as COO of InVivoLink since its creation in 2009. Most recently, he has been leading efforts to integrate InVivoLink’s Web-based care management platform with the orthopedic and spine service line strategies of providers. The need for value-based care management is being highlighted by the Centers for Medicare & Medicaid Services through its new Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) initiatives.

Prior to joining InVivoLink, Bass served as COO of Titan Management Group, an emerging software services company. He was also on the startup team of empactHealth.com, a Web-based e-procurement provider later acquired by Global Healthcare Exchange (GHX).

“John has worked closely with HealthTrust on a variety of strategic initiatives,” says HealthTrust CEO Ed Jones. “He has become a trusted resource for our leadership team and I’m delighted to have him overseeing our broader goal of helping providers capitalize on emerging clinical and operational opportunities.”

A Nashville native, Bass holds a bachelor’s degree in chemistry from The University of North Carolina at Chapel Hill.

About InVivoLink
InVivoLink, Inc. provides care management technology and services used to optimize care delivery for orthopedic and spine procedures. Using data collected by InVivoLink across the continuum of care, hospitals and surgeons can have meaningful, evidence-based discussions that improve each patient’s experience. Providers also use InVivoLink to design the optimal care for future patients beginning when the patient is scheduled for a procedure. When used at scale, InVivoLink’s registry allows providers to employ market-based bundled payment strategies focused on operational excellence. InVivoLink has more than six years of experience managing value-based care in orthopedics. For more information, visit www.invivolink.com.

About HealthTrust
HealthTrust (legally known as Healthtrust Purchasing Group, L.P.) is committed to strengthening provider performance and clinical excellence through an aligned membership model and the delivery of total cost management solutions, including supply chain solutions and a contract and service portfolio unparalleled in quality, scope and value. HealthTrust (www.healthtrustpg.com) serves over 1,400 acute care facilities and members in more than 22,300 other locations, including ambulatory surgery centers, physician practices, long-term care and alternate care sites. Headquartered in Brentwood, Tennessee, HealthTrust is an affiliate of Parallon Business Solutions, LLC (www.parallon.com), a leading provider of healthcare business and operational services, including revenue cycle management, workforce and technology solutions. On Twitter @healthtrustpg and @parallonconnect.