Comprehensive Care for Joint Replacement Model (CJR) Will Impact PTs. The APTA has analyzed this for you…

The APTA has proactively broken down key components of the CJR for physical therapists to understand.   Below is their analysis and tools to assist you in better understanding what is happening…
The Comprehensive Care for Joint Replacement Model (CJR) is a new payment model being tested for episodes of care related to total knee and total hip replacements under Medicare. The model will be tested in 67 metropolitan statistical areas for 5 years beginning April 1, 2016. Programs under the model will be administered by hospitals in the participating areas, and physical therapist practices will be impacted in those areas. Take a moment to learn about the model and determine if you should be thinking of marketing your practice to a CJR program.

Step 1: Understand CJR

Every Medicare total hip and total knee replacement procedure within the designated areas will be administered through CJR, including rehabilitation components of the episode of care. But even if you don’t practice within a CJR area, similar models are sure to follow this lead, and there will be opportunities for physical therapist practices at large to be involved. Get a jump on the trend and use these resources to understand the implications of CJR and other bundled payment models.

• Webinar: Medicare CJR Models: Impact on the General PT – FREE for APTA members!
• Presentation Slide Deck: Learn the Basics of CJR (.pdf)
• Common questions: See our FAQs (pdf) (coming soon)

Step 2: Determine if Becoming a CJR Collaborator Is Right for Your Practice

All total knee and total hip replacement procedures in the selected areas will be included under the CJR model. You can choose to actively become a collaborator under the CJR model or passively see these patients under your traditional payment structure. There are several details PTs need to consider before becoming a collaborator.

• CJR contracting checklist (.pdf)

Step 3: Understand the Contracting Process

Becoming a collaborator in the CJR model will require contracting with a participating hospital(s). APTA has created a contracting toolkit that can be used in conjunction with APTA’s managed care contracting toolkit that will help you identify important contracting considerations.

• CJR contracting toolkit (.pdf)

Step 4: Stay Up-to-Date on Clinical Practice Resources

Whether or not you’re an active collaborator in a CJR bundle, delivering consistent evidence-based care, tracking your outcomes, and educating potential collaborating providers are keys to success in this practice model and in most other new payment models moving forward. Read more about evidence-based care and tracking outcomes data with the following resources:

Guide to Physical Therapist Practice

The Guide to Physical Therapist Practice (Guide) provides the description of physical therapist practice, which may be helpful in educating others on the role of physical therapy in collaborative care teams. Physical therapist intervention may result not only in more efficient and effective care, but also in more appropriate use of other members of the primary care team.

• Introduction to Guide
• Discussion of measurements and outcomes
• Categories of tests and measures
• Interventions

PTNow

APTA’s PTNow includes relevant evidence-based information to help with the management of patients with total joint replacements.

• TKA clinical summary
• Falls risk clinical summary
• Knee Injury and Osteoarthritis Outcome Score (KOOS) test
• Rehabilitation Reference Center (Explore search results on joint replacement.)

Additional Resources

To extend the benefits of your treatment and help your patients improve or maintain their mobility and independence even after total joint replacement (TJR), the following evidence-based community programs emphasize physical activity and self-management to decrease the chance of readmission.

• Evidence-based community programs for arthritis management
  Finding the right physical activity program can extend the benefits of your treatment and help your patients maintain their mobility and independence.
• Balance and falls information
  Falls after TJR can lead to unplanned readmissions. It is important that you evaluate each patient’s risk for falls.
• Physical therapy’s role in reducing hospital readmissions
  Physical therapists have expertise in providing recommendations for the most appropriate level of postacute care following surgery. You can make the case for being included in the health care team prior to and during care transitions to help in reducing hospital readmissions.
• Outcome measures
  It is important to measure and report patient care outcomes within the relevant components of function to show best clinical practice to patients, providers, and payers.
• Telehealth information
  Telehealth technologies may help with the recovery period after hip or knee replacement surgeries. Review APTA’s guidelines on providing physical therapy using telehealth as well as issues to be aware of before you proceed.

APTA Summaries and Comments on the CJR Model Ruling

The following APTA summaries and comments to the federal government explain how the CJR model will affect the physical therapy community.

• Summary: Final Rule for 2016 on Comprehensive Care for Joint Rehabilitation Model (.pdf) – 12/14/15 
• Summary: Proposed Rule for 2016 on Comprehensive Care for Joint Rehabilitation Model (.pdf) – 8/3/15 
• Comments: Proposed Rule for CJR Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Service (.pdf) – 9/8/15

Questions regarding CJR should be sent to advocacy@apta.org.