The Case Manager and Mandatory Bundles

by Stefani Daniels, Managing Partner
Published on Oct 06, 2015

The Comprehensive Care for Joint Replacement (CCJR)initiative may be the first mandatory bundle proposed by CMS, but it won't be the last as the industry moves from fee-for-service to fee-for-value.

CMS is forcing a change in perspective as it moves from a voluntary program of bundled payments under the Bundled Payments for Care Improvement (BPCI) initiative, to a mandated program of bundled payments for orthopedic procedures.  The Comprehensive Care for Joint Replacement (CCJR) initiative will hold hospitals accountable for the initial hospitalization and all care in the 90-day window after discharge, including hospital care, post-acute care, and physician services for Medicare patients undergoing hip and knee replacement surgery. 

This may be the first mandatory bundle, but it won't be the last in the industry's move from fee-for-service to fee-for-value.  For a hospital to succeed in this new marketplace, it will need:

  1. A pro-active care management model.
  2. Risk profiles to select patients who will benefit from a care manager's attention.
  3. Care manager's interventions to mitigate progression-of-care risk.
  4. Post acute care partners committed to quality outcomes.
  5. A single care manager to serve as the consistent resource for patients along the entire continuum.  

For real-world insight on how to develop a contemporary care management model, give us a call at 954.941.6505.