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December 21, 2015 by Yash Mehta

CMS Bundled Payment for New Joint Replacement Model Includes mHealth

As Medicare ( continues to expand their drive for patient-centered care, they have expanded now to include Comprehensive Care for Joint Replacement (CJR). Knee and hip replacement procedures remain one of the most commonly performed surgeries in United States with over million procedures performed annually (CDC Inpatient Surgery Data). With such commonality of the procedures, the health and financial impact on the healthcare system becomes clear.

Medicare has been progressively trying to push for new programs to improve the quality of care, reduce readmissions, improve patient outcomes, and reduce cost. Beginning 2015, Medicare introduced Chronic Care Management with reimbursement of non face-to-face care, thus encouraging the direct use of mHealth applications and telemedicine.

What is CJR?

With the new bundled payment for Comprehensive Care for Joint Replacement, the focus is to improve care and reduce cost of care. The final rule (Comprehensive Care for Joint Replacement), released on November 16 2015, will go into effect in April of 2016. Improving the quality of care and reducing the cost of care occurs through the entire period of pre and post-op care – approximately 90-day program.

By focusing on common medical procedures and large patient demographics, Medicare can encourage the use of technology to improve population health.

What about mHealth?

The program will incentivize the use of mHealth platforms for achieving the broadly listed goals. Infact, some mHealth technologies are developed with chronic care or CJR as the target groups. Chronic care and post-op recovery (amongst others) are two patient groups who can benefit the most from mHealth platforms for consistent and comprehensive care.

Within the CJR model, the participating hospital can spend up to $1000 per CJR patient to provide follow-up care (for the entire episode) using an item, technology, or service. Specifically, the Rule states:

  • Increasing the beneficiary’s engagement in the management of his or her own health care
  • Adherence to a treatment or drug regimen
  • Adherence to a follow-up care plan
  • Reduction of readmissions and complications resulting from LEJR procedures
  • Management of chronic diseases and conditions that may be affected by the LEJR procedure

These specifications enable the hospitals to directly use mHealth monitoring apps & platforms along with any medical equipment (incl. wearables, vitals measuring equipment, etc.) to provide post-op care.

How does it benefit?

The continuum of care over the entire episode ensures that the patient is:

  • Adequately prepared for the surgery (pre-op care)
  • Does not miss the surgery (Patients do miss their surgeries occasionally – ~$5000 in costs to the hospital for missed surgery)
  • Reduce the chance of complication during recovery (post-op)
  • Easily self-manage the recovery care plan as directed by the Medical Staff (post-op patient engagement)
  • Quickly alert the Medical Staff of any changes/fluctuations in the health status & recovery
  • Seamless connection to the Medical Staff

The Medical Staff benefits from usage of such technology for CJR program by:

  • Consistent patient-feedback
  • Consistent actionable data for preventive care and pre-emptive intervention
  • Medication compliance

The benefits and the gains achieved using mHealth for CJR program enable cost-savings and efficiency for the healthcare system as well. The CJR program will greatly impact how care is delivered in the coming years; specifically, how technology will be integrated into patient care.

More Info: Comprehensive Care for Joint Replacement Model

About DoctoDoor

DoctoDoor is a dynamic remote monitoring platform with focus on Chronic Care Patients and Post-op Recovery. DoctoDoor enables consistent care and management of the patients with seamless connection between the patient and Medical Staff. DoctoDoor care protocol ensure that the patient is on track to recovery while allowing the Medical Staff to assess the patient using quantitative and qualitative data.

Please Contact Us to learn more and see how DoctoDoor can benefit you.