60% of hospitals at risk of CCJR cost penalties, study finds

Nearly 60 percent of hospitals participating in Medicare's Comprehensive Care for Joint Replacement model could face penalties based on their cost performance, according to a new report from Avalere.

Under the new payment model, which begins April 1, about 480 of 800 particiapting hospitals will be at risk for penalties associated with higher costs than their regional peers for hip and knee replacements and related charges within 90 days of discharge. The CCJR payment model will be mandatory for most hospitals within 67 markets.

The report found about 39 percent of total spending on hip and knee replacement episodes is tied to post-discharge care, including post-acute care facilities and hospital readmissions. Under the CCJR model, hospitals will be held accountable for reducing healthcare spending through 90 days post-discharge, making it critical for hospitals to reduce post-acute care spending.

"The reality is that most hospitals don't know where their patients go after they are discharged," said Fred Bentley, vice president at Avalere. "Their success under CCJR will hinge on being able to track patients and partner with high-performing post-acute care providers."

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