JFK Health Succeeds in First Year of CJR Program with PMMC

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JFK Health Leveraged PMMC’s Bundled Episode Analytics to Reduce Spend and Earn Repayment

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We quickly realized by drilling the data down to the Service level that Skilled Nursing Facilities (SNF) were a cost strain. The PMMC model allowed us to identify the “sweet spot” between SNF length of stay and exceeding the stop gain.

PMMC, a leading revenue cycle management company, helped JFK Health complete a successful first year in the Comprehensive Care for Joint Replacement (CJR) program by providing bundled episode analytics and a collaboration strategy with its physicians to reduce spend and earn a repayment from CMS.

PMMC provided JFK with actionable analytics so the organization could quickly evaluate spend performance among its post-acute care (PAC) providers and pinpoint the cost savings opportunities. By the completion of the first year, JFK Health finished $242,000 under the episode spend target and earned a repayment of $171,000 from CMS after the stop-gain limit was applied.

“The data is what provides the insight for the hospitals to make decisions to hit the targets,” explained Steve Miller, Director of Managed Care at JFK. “We quickly realized by drilling the data down to the Service level that Skilled Nursing Facilities (SNF) were a cost strain. The PMMC model allowed us to identify the “sweet spot” between SNF length of stay and exceeding the stop gain”.”

JFK Health decreased its length of stay by more than 50 percent -- from 21 to 10 days.

The model, which requires hospitals to manage spend across the entire episode of care, is uncharted territory for many providers. An inherent challenge in this model is the need to build collaboration among the hospital and its physicians.

To help build this collaboration strategy, PMMC consulted with the physicians at JFK Health. By presenting a transparent, third-party perspective supported by data, JFK’s physicians responded positively.

“The relationship with a third-party like PMMC is unquantifiable. It made the process more transparent and really solidified the message of the need for collaboration,” added Steve Miller.

Going forward into the second year of the program, JFK Health envisions its physicians being more engaged and taking more of a leadership role.

JFK Health is one of approximately 800 hospitals required to participate in the CJR model, a five-year program intended to hold hospitals financially accountable for the quality and cost of a CJR episode of care and incentivizes increased coordination of care among hospitals, physicians, and post-acute care providers.

With PMMC’s bundled episode analytics, hospitals can easily compare its own costs for the entire episode to CMS targets – as well as internal benchmarks – on a quarterly basis.

About PMMC

PMMC provides high value revenue cycle software and services to improve the financial performance of healthcare organizations. Our software and expertise focuses on payment accuracy and identifying more revenue opportunities across the revenue cycle.

PMMC helps hospitals identify underpayments and denials, increase price transparency, and manage bundled payments. Clients see, on average, a 10 to 1 return on investment with software and services.

About JFK Health

JFK Medical Center, an affiliate of JFK Health, is a 498-bed full-service, acute care hospital, and the adjacent JFK Johnson Rehabilitative Institute. Located in the heart of Edison, NJ, it has remained at the forefront of quality care in the region since its inception in 1967. Today, JFK accommodates more than 20,000 admissions, 3,000 births and 60,000 Emergency Room visits on a yearly basis. The Medical Center features a complete array of services, including general surgery, emergency medicine, mental health, orthopedics, maternity and pediatric care. It is home to two world renowned institutes: the JFK Neuroscience Institute and the JFK Johnson Rehabilitation Institute, as well as JFK Haven Hospice, JFK Imaging Center and the Center for Wound Healing.

JFK Medical Center is proud to be rated the #1 stroke program in New Jersey and in the top 5% in the entire country. With a Gold Plus award for stroke care by the American Heart Association and a comprehensive and primary stroke center designation, our neuroscience program is unmatched with both neurological and rehabilitation services.

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Brad Josephson
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