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Understanding the Risks and Opportunities of the Comprehensive Care for Joint Replacement Model 
 
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Overview
Lower extremity joint replacements (LEJR) are one of the most frquent procedures for Medicare patients. In 2013, there were more than 400,000 Medicare LEJR inpatient primary procedures, costing more than $7 billion for hospitalization alone. The average Medicare expenditure for LEJR surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas.

The Centers for Medicare and Medicaid Services have selected LEJR procedures for a new model to test bundled payment and quality measurement for an episode of care, to encourage providers to work together from initial hospitalization through recovery.

The CMS Innovation Center announced the Comprehensive Care for Joint Replacement (CCJR) model on July 9, 2015. This model constitutes a mandatory shift to episode-based payment for certain lower extremity joint replacement services in specific regions throughout the country. The model requires inpatient facilities to take financial risk for a broad range of services that could be furnished to Medicare beneficiaries within a 90 day period following certain joint replacements.
 
Under the model, retrospective reconciliation will compare the actual spending on CCJR episodes to the predetermined target price. If actual spending is below the target, hospitals stand to receive an additional payment. If actual spending is above the target, hospitals will be required to repay CMS for overages.
 
In order to succeed under CCJR, a key requirement is developing an understanding of the patterns of care in the 90 days after hospital discharge. Much of the savings within CCJR episodes will be in this 90 day post-acute period where there is substantial variation in utilization and cost across beneficiaries.
 
During this presentation, an overview will be given of the key features of the CCJR model. Examples of possible savings opportunities will be provided, and participants will learn how they can estimate the potential effect CCJR will have on their practice pattern and revenue cycle. Please join us on Thursday, August 13th at 2PM Eastern as Millimanís Pamela Pelizzari conducts an expert, in-depth session on the Comprehensive Care for Joint Replacement model.
 
Learning Objectives
Participants will be able to:
  1. Overview the structure and requirements of the proposed Comprehensive Care for Joint Replacement (CCJR) model
  2. Consider the potential implications of CCJR on their financial bottom line
  3. Explore techniques to internally identify CCJR related opportunities that could lead to success
  4. Identify potential savings opportunities with the CCJR model
  5. Understand how to estimate the potential effect CCJR will have on their practice pattern and revenue cycle
  6. Engage in interactive learning through online question submission, attendee feedback and opportunity for follow-up questions, and networking with attendees, faculty and other professionals through a dedicated LinkedIn group.
Who Should Attend

Interested attendees would include:

  • C-Suite Executives
  • Revenue Cycle Management Executives and Staff
  • Finance Executives and Staff
  • Managed Care Executives and Staff
  • Medical Directors
  • Care Management Executives and Staff
  • Provider Network Executives and Staff
  • Provider Contracting Executives and Staff
  • Strategy and Planning Executives and Staff
  • Innovation, Integration and Transformation Executives
  • Clinical and Business Intelligence Staff
  • Other Interested Parties

Attendees would represent organizations including:

  • Hospitals and Health Systems
  • Medical Groups
  • Provider Networks
  • Accountable Care Organizations
  • Other Providers
  • Pharmaceutical Organizations
  • Care Management Organizations
  • Health Plans
  • Solutions Providers 
  • State and Local Government Agencies
  • Associations, Institutes and Research Organizations 
  • Media
  • Other Interested Organizations


Registration
Understanding the Risks and Opportunities of the Comprehensive Care for Joint Replacement Model 
 
  Individual Registration Fee: $195. Post-event materials with video syncing slides and recorded audio, plus presentation pdf file: $45 for attendees; $260 for non-attendees after the event. Register online or download the event brochure.
 
 
 
Register Now   Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!
 
 
Faculty
Pamela Pelizzari, MPH
Pamela Pelizzari, MPH
Healthcare Consultant
Milliman
 

Pamela is a healthcare consultant with the New York office of Milliman. She specializes in the development and management of episode-based payment methodologies. She joined the firm in 2014. Pamela has a broad background in integrated delivery system administration and healthcare payment reform. She has worked in both clinical and payer settings and has experience in alternative risk contracting strategies.

Pamela has particular expertise in analysis of healthcare claims and the development of episode-based payment definitions and benchmarking methodologies. She also has experience implementing both prospective and retrospective payment methodologies, including developing gainsharing methodologies, claims adjudication techniques, and quality monitoring programs.

Prior to joining Milliman, Pamela served as a senior technical advisor at the Centers for Medicare and Medicaid Services (CMS). She was responsible for developing and implementing novel payment methodologies to transform healthcare delivery and payment nationwide. Pamela played a key role in designing the national Bundled Payments for Care Improvement initiative, with thousands of participants nationally. She also led the development of an oncology episode-based payment model as well as other specialty physician-focused bundled payment models. Previously, Pamela worked at an academic medical center, building consensus for redesigning care delivery among diverse stakeholders including physicians, administrators, and patient advocates.

Pamela received her ScB at Brown University, where she studied applied mathematics. She was also a Sommer Scholar at the Johns Hopkins Bloomberg School of Public Health, receiving her MPH with a focus on health policy and management.

 
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