Comprehensive Care for Joint Replacement (CJR) and Bundled Payments

The Comprehensive Care for Joint Replacement (CJR) model is a mandated orthopedic bundle that aims to improve the quality and reduce the cost and cost variance of hip and knee replacement surgery. According to Medicare, the expenditure for joint replacement surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across different US geographic areas. The CJR bundle (covering MS-DRGs 469 and 470 MS-DRG 469) is apart of the Bundled Payments for Care Improvement (BPCI) initiative, where a fixed cost determined by Medicare is assigned to an episode of care, like joint replacement surgery, to incentivize greater coordination and cost control amongst providers.

For the first time, hospitals are financially accountable for the quality, cost, and postoperative outcome of joint replacement surgery.

What Does CJR Mean for Hospitals?

From surgery day through to 90 days post-discharge, the hospital is financially tied to all sets of treatment and care a patient receives--whether from a skilled nursing facility (SNF), home health agency (HHA), inpatient rehabilitation facility (IRF) and so forth.

At the end of a performance year, if quality requirements are met and costs are below those set by CMS for the episode, the hospital is financially rewarded for the difference between the target price and actual episode spending. If costs exceed the target price, the hospital--and the hospital only--must make a reconciliation payment to cover a portion of the overage to CMS.

scale representing balancing the hospital budget


At the end of the year, depending on the hospital’s quality and cost performance for the episode, the hospital will either earn a financial reward or have to make a retrospective, end-of-year reconciliation payment to Medicare.

three month calendars that represent the 90 day post joint replacement surgery window in the CJR bundle

90 days Post-Discharge

Hospitals and physicians are responsible for the post-operative care, costs and outcomes of a patient after they've left their care center.

diagram showing hospital stake holders with arrows representing coordination in hospitals

Coordination with Care Teams

Incentive to work closely with and align interests with other members of the patient’s care team, such as physicians, skilled nursing facilities (SNF), and home health agencies (HHA) to provide higher quality cost, for less.

if you come in under the CJR bundle price, surgeons can get gainsharing bonuses

Establish Gainsharing Collaborators

Motive to arrange relationships with pre-designated health care providers (collaborators) to align interests by sharing rewards paid out by Medicare.

hospital/surgeon parternships are important for winning CJR

Build a Real Hospital/Doctor Partnership

Physicians help determine the standards for care settings, choose the patient discharge location and influence patient choice of post-acute care provider. They are a pivotal part of effectively executing a winning CJR plan.

doctor wanting to provide a good patient experience for his joint replacement patients

Redefine "Quality of Care"

Hospitals can achieve a 50% episode discount if they can reach high quality performance by reducing surgical complications, submitting patient reported outcomes and more.

Who Has to Participate in CJR Model?

As of November 2015, 800 hospitals, across 67 geographic areas are required to implement the CJR bundle. The mandated hospitals are those using the Inpatient Prospective Payment System (IPPS) and located within the defined metropolitan statistical areas (MSAs).

Who's Excluded from CJR Bundles:

  • Hospitals outside the selected geographical areas or in MSA's with an urban center with a population less than 50,000 people
  • Hospitals participating in Model 1, 2 or 4 of the Bundled Payments for Care Improvement (BPCI) initiative for LEJR episodes.

How PeerWell Can Help Your Hospital Succeed with CJR

PeerWell helping the hospital reduce costs by sending more joint replacement patients straight home

1. Improve Your Bottom Line

Bringing PeerWell PreHab into your hospital can boost patient discharge straight to home eligibility. On average, 15% of patients are discharged straight home after joint replacement surgery. The episode of care cost for these patients is just $15,744 which is 34% less than the average episode cost in the US.

the hospital likes to send patients straight home after a joint replacement to keep the cjr bundle price down

2. Indirectly Control Post-Acute Care Costs

Drastically reduce the post-acute costs associated with the episode by controlling the discharge location. 54% of CJR episode of care costs occur post-op as majority of patients go into costly IRFs, SNFs or LATCHs once discharged. Graduates of PeerWell's evidence-based PreHab program are health optimized, mentally and physically prepared, and have practiced the competence activities required for discharge home.

a meter representing the quality score a hospital gets

3. Boost CJR Quality Measure Score

Improve on the quality measures that determine your eligibility for Medicare's financial performance reward. THA/TKA complication rates and can be improved with PeerWell's PreHab program that preemptively curbs risky patient behaviors and conditions and actually improves patients physical and mental health.

Use our discharge straight-to-home calculator to see how improving just one percentage point can fast track your CJR Bundle costs.

PeerWell’s CJR Post-Acute Care Discharge Savings Slider

After knee or hip replacement surgery, the national discharge rate straight home is approximately 15%. Increasing the number of cases discharged home, that avoid costly secondary care locations, offers a massive opportunity for episode savings.

Use the Discharge Savings Slider to see the average hospital savings for each straight-home percentage point increase.

Are you and your hospital affected by CJR?

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happy joint replacement patients who used peerwell prehab and their doctor