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CJR: Three Organizational Challenges and How to Prepare For Them

By Ellen Strunk, PT, MS, GCS, CEEAA, CHC

on February 17, 2016

Categories: Enterprise, Geriatrics, Industry Trends, Occupational Therapy, Orthopedics, Physical Therapy

Are patients recovering from a total joint replacement (TJR) a significant part of your therapy practice?

In my previous article, 8 Quick Facts About the Comprehensive Care for Joint Replacement Program, I shared the significant changes coming this calendar year for TJR. Below are ideas to combat three challenges the new mandated program will place on your organization.

Each hospital in the Comprehensive Care for Joint Replacement (CJR) program markets will determine how to partner with post-acute care providers in their market. As a result, how the CJR is implemented is likely to vary across the country. But here are a few things physical and occupational therapists can begin to think about in preparation.

1. Transitions

Regardless of the setting you work in, improving communication with the provider upstream or downstream of you is very important. Communication is key to ensuring the patient is safely and seamlessly transferred to the next site of service.

A recent study published in the Archives of Physical Medicine and Rehabilitation¹ demonstrated that when PT recommendations made during a hospital stay in high-risk patients were omitted from the hospital discharge communications to subacute care facilities, the beneficiaries experienced more negative 30-day outcomes (rehospitalization, emergency department visit, and/or death).

Even though this study focused on hospital discharges, it proves the point that therapy recommendations are extremely important to the safety and well-being of our patients. Therefore, whether you currently practice in a hospital, skilled nursing facility, inpatient rehabilitation, or home health, begin working with your colleagues and administrators on how the communication will flow into and out of your practice.

2. Medically Necessary, Cost Effective Care

Reducing inefficiencies and redundancies will be important to a program’s success. Therapists working in these areas should consider if the development of clinical pathways or care maps is beneficial. While some therapists may feel this approach reduces their ability to practice autonomously, pathways that are focused on clinical interventions should not be feared.

Another strategy is obtaining more information from the discharge planners and admissions coordinators at your facilities or agencies. These people are key to ensuring the safe and effective transition. Traditionally, it is easy to dismiss this idea as ‘too difficult’ or ‘we’ve asked for it for years and have never gotten it.’ The difference now is that everyone involved with the CJR program has an incentive to work together. The CJR program is the first mandated program that puts the burden of collaboration on the providers.

Take the initiative to let your discharge planners and admissions coordinators know what you need from the prior service setting and what should be sent to the next service location. You may want to develop an information sheet with vital information you need upon referral or require that discharge summaries are completed timely so they can be sent to the next provider. Consider including exercise flow sheets or description of mode, intensity, and frequency of exercises performed, so the next therapist can advance the patient rather than wasting critical time in repeating exercises.

3. Outcomes

Functional outcome measurement is a necessary part of patient care today. No one wants to pay for services that are unnecessary, and the Medicare program certainly thinks that way. If your organization is currently not collecting any type of standardized functional outcome measure, you will want to seriously consider starting. Providers who are able to demonstrate the effectiveness of what they do in terms other than “progressing well” and “maximum potential met” will be the providers of choice in the future. Consider collaborating with other therapists in your area and your care partners upstream and downstream to discuss the feasibility of collecting outcomes using the same instrument.

The CJR program is just the beginning of what providers can expect over the next decade: a shift in focus from “setting-specific” measures and payment to “condition-specific” measures and payment. Hospital systems are bearing the primary risk for this current TJR care model. Therefore, providers who want to partner with them to offer therapy for hip and knee joint replacement patients will need to demonstrate a thorough understanding of what the program means and demonstrate that they are prepared.

MedBridge Solution for CJR

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Enhance communication and increase efficiencies with other providers by laying out a clear path to recovery using our robust home exercise program.
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Ellen Strunk, PT, MS, GCS, CEEAA, CHC

Ms. Strunk specializes in helping clients understand the Medicare prospective payment systems for skilled nursing facilities and home health agencies, as well as the Medicare conditions of participation for rehab agencies and outpatient billing for all provider types. Her experience includes utilizing medical record reviews and data systems to help both inpatient and outpatient therapy providers meet regulatory guidelines and prepare for the shift to value-based care. She has worked with clients on a variety of Medicare/Medicaid payment and certification matters, including substantial overpayment assessments and facilitation of Corporate Integrity Agreements. Ms. Strunk lectures nationally on the topics of coding, billing, and documentation to meet medical necessity and payer guidelines, value based-purchasing, incorporating clinical outcomes into practice, pharmacology in rehabilitation, and developing meaningful exercise programs.

References:

Polnaszek B, et al. Omission of Physical Therapy Recommendations for High-Risk Patients Transitioning From the Hospital to Subacute Care Facilities. Archives of Physical Medicine and Rehabilitation (2015 Nov;96(11):1966-72.e3.)