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CJR Policy

CJR Policy

13695 US Highway 1
Sebastian, FL 32958
772-589-3186

knee pain

Comprehensive Care for Joint Replacement

Sebastian River Medical Center is participating in a Medicare initiative called the Comprehensive Care for Joint Replacement (CJR) model. The CJR model aims to promote quality and financial accountability for care surrounding lower-extremity joint replacement (LEJR) procedures, commonly referred to as hip and knee replacements and/or other major leg procedures.

The following list includes health care providers and suppliers that have established a collaborator agreement with Sebastian River Medical Center in order to share in financial rewards and/or losses in the CJR model. 

Sebastian River Medical Center’s CJR Collaborators
  • Anthony Ware, MD
  • Kirk Maes, MD
  • Richard Steinfeld, MD
  • Carl Delella, D.O.
  • Kenneth Sands, MD
  • Mark J. Davis, MD
  • Jason Stacks, MD
Past Collaborators
  • Michael D. Watson, MD

If you have questions or want more information about the Comprehensive Care for Joint Replacement (CJR) model, call Sebastian River Medical Center at (772) 589-3186 or call 1-800-MEDICARE. You can also find additional information at https://innovation.cms.gov/initiatives/cjr.

 

CJR Policy

Comprehensive Care for Joint Replacement (CJR) Program Collaborator Selection Policy

Effective Date: 4/1/2016

Sebastian River Medical Center, designated by the Centers for Medicare and Medicaid Services (CMS) to participate in the CMS CJR program, maintains written policies for selecting providers and suppliers for sharing risk and gains as CJR collaborators as follows:

1. Policy

CJR Collaborator selection shall be made in accordance with all relevant laws and regulations, including the applicable fraud and abuse laws and all applicable payment and coverage requirements as defined for CMS model and the CJR programs. Selection criteria are not based directly or indirectly on the volume or value of referrals or business otherwise generated by, between, or among the hospital, CJR collaborator, and any individual or entity affiliated with the hospital or CJR collaborator.

2. Definitions

CJR activities

Activities related to promoting accountability for the quality, cost, and overall care for CJR beneficiaries, including managing and coordinating care; encouraging investment in infrastructure enabling technologies and redesigned care processes for high quality and efficient service delivery; the provision of items and services during a CJR episode in a manner that reduces costs and improves quality; or carrying out any other obligation or duty under CJR.

CJR collaborator

one of the following Medicare-enrolled persons or entities that enters into a sharing arrangement:

(1) Skilled nursing facility (SNF); (2) Home health agency (HHA); (3) Long-term care hospital (LTCH); (4) Inpatient rehabilitation facility (IRF); (5) Physician; (6) Nonphysician practitioner; (7) Therapist in private practice; (8)  Comprehensive Outpatient Rehabilitation Facility (CORF); (9)  Provider of outpatient therapy services; (10)  Physician Group Practice (PGP); (11)  Hospital; (12) Critical Access Hospital (CAH); (13) Non-Physician Provider Group Practice (NPPGP); (14) Therapy Group Practice (TGP); (15) Accountable Care Organization (ACO).

3. Criteria

Privileged to perform a surgical procedure in MS DRGs 469, 470, 480, 481, 482
Eligible to participate in Medicare
Commitment to participate in CJR activities, including:

  • Attends 75% of Care Redesign Workgroup meetings

  • Attends Quarterly Data Review meetings

  • Notifies hospital facility designee of at least 80% of elective CJR admissions at least 14 days in advance in a mutually determined format