Home Health & Hospice Week

Shifting hospital discharges from facilities to home care helped shave $17 million off Medicare spending.

A new analysis of Medicare’s Compre­hensive Care for Joint Replacement (CJR) model shows that home care can produce savings for the benefit program.

Reminder: Under the five-year CJR model which began in April 2016, participating hospitals are financially accountable for the quality and cost of health care services during the episode, which begins with the hospitalization for the surgery and extends for 90 days after the hospital stay.

Newly released analysis from the Centers for Medicare & Medicaid Services covers the first two years of the program, which includes 147,923 lower extremity joint replacement (LEJR) episodes initiated by 733 hospitals in 67 randomly selected metropolitan statistical areas. Medicare saved $17.4 million or 0.5 percent of baseline payments, the agency estimates. That includes $128.9 million in reconciliation payments CMS made to hospitals.

“Changes in post-acute care use, suggesting shifts to less intensive sites of care, contributed the most to the decrease in episode payments,” CMS says. “Discharges to inpatient rehabilitation facilities went down. The proportion of LEJR patients first discharged home with home health care rose. The proportion of LEJR patients first discharged to skilled nursing facilities remained constant, but the average length of stay decreased, which resulted in lower payments.”

To change those discharge patterns, hospitals “reported initiating discharge planning before the hospital admission to educate patients that the goal is discharge directly home (with home health or outpatient therapy),” among other steps, CMS says.

Hospitals also “engag[ed] surgeons in efforts to redirect patient discharge destination from SNFs to home,” the report says.

The 100-page CJR Performance Year 2 Annual report is at https://innovation.cms.gov/Files/reports/cjr-secondannrpt.pdf.