White Papers

Insight From True Thought Leaders

DataGen’s subject matter experts are constantly interpreting shifts in the healthcare landscape. We share our thoughts and analysis in our white papers, tailored to give our audience a better understanding of the issues facing the industry today.

November 20, 2015
CMS has released its final rule for the Comprehensive Care for Joint Replacement (CJR) model.   In addition to dropping one “C” from the acronym, there are several substantive changes from the proposed rule; most important of which is that the program will now begin on April 1, 2016.  DataGen is revising its analytics to reflect all of the changes.   We will be ready to share insight on opportunities under CJR prior to the program’s official start. We have updated our "Ten Things" paper to reflect the final rule. Download Now

October 14, 2015
Hospitals may be the only risk-bearing entities under the Centers for Medicare and Medicaid Services' (CMS) Comprehensive Care for Joint Replacement (CJR) payment model, but there are major implications for post-acute care (PAC) providers.  Based on our review of the CJR program, this white paper outlines the top seven things PAC providers need to know about and act on to be successful partners in this and other emerging payment models. Download Now

August 21, 2015

In July 2015, the Centers for Medicare and Medicaid Services (CMS) proposed its Comprehensive Care for Joint Replacement (CJR) payment model, a pilot bundled payment program for the most common inpatient surgeries for Medicare beneficiaries—hip and knee replacements, known as lower extremity joint replacements (LEJRs). While CMS’ increasing interest in bundled payments has been apparent, the announcement of this mandatory initiative was a surprise to many, given that the Bundled Payments for Care Improvement (BPCI) demonstration program, initiated in 2013, is still in its early stages.  CJR would be mandatory for hospitals in 75 Metropolitan Statistical Areas (MSAs).

This white paper examines the top ten things every hospital executive should know about the proposed CJR program, its relationship to the BPCI demonstration, and the implications of this model for other innovative payment models. Download Now

July 15, 2015
On July 9, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule describing its Comprehensive Care for Joint Replacement (CJR) payment model, a pilot bundled payment program for major lower extremity joint replacements. While CMS’ increasing interest in bundled payments has been apparent, the announcement of this mandatory initiative was a surprise to many, given that the Bundled Payments for Care Improvement (BPCI) demonstration program is still in its early stages for many participants. In addition, CMS recently requested comments on the expansion of the BPCI program, which it states is not related to the CJR pilot. Nonetheless, CJR, which will be mandatory for about 1,200 hospitals, appears poised for implementation in January 2016. This article presents an overview of the CJR program, highlighting its major components and comparing it to the BPCI program.  We summarized and omitted some of the details of the 438-page CMS proposal, so please refer to that document for specific details. Download Now

April 23, 2015
What is the most cost-effective post-acute care setting for rehabilitation after a medical or surgical hospital stay—an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF)?  It is widely assumed that rehabilitative care in an IRF may be more effective because of its higher-intensity programs, lower lengths of stay, and fewer readmissions.  But, is this the full story? Download Now

August 18, 2014
A new approach to data-driven decision making

Healthcare reform initiatives, driven by government, healthcare providers, and payers, are shifting the focus of care delivery and payment from individual points of service to the whole patient and entire populations. This transition from “volume” to “value” (or population health) requires a mindset change for hospitals, health systems, and other providers. It necessitates an expanded perspective based on patient-centered analytics that encompasses the full spectrum of care for patient populations—from primary to post-acute services—to improve health and outcomes while reducing costs.

June 3, 2014
"Shock and awe" were words that many of our clients used when they received their Bundled Payments for Care Improvement, or BPCI mock reconciliation data from the Centers for Medicare and Medicaid Services (CMS) in early May. Some were dismayed at the significant reduction in financial surpluses from those that were expected, while others were alarmed by several apparent policy changes that have been implemented without notice and after contracts were signed. This article will discuss what we expected to see, what we actually saw, what we see as the consequent effects on reconciliation, and where we believe policy changes must be forthcoming. Download Now

May 23, 2014
By exploring the regional variations in Medicare payments for 90-day episodes of care (those beginning with a hospitalization that also includes post-acute care), this report provides key findings from an analysis on four different clinical episodes/areas of care: acute myocardial infarction, congestive heart failure, pneumonia and major hip and knee joint replacements. Download Now

January 15, 2014
The Centers for Medicare and Medicaid Services (CMS) is allowing providers that are already participating in the Bundled Payment for Care Initiatives (BPCI) program to evaluate expanding their participation to additional episode families. This article provides a structured approach to those providers for analyzing and evaluating new episode families for inclusion in BPCI. Download Now

August 19, 2013
An overview of the Bundled Payment for Care Improvement, citing the challenges experienced by both participants and CMS, and sharing lessons learned by New York-Presbyterian Hospital and its data analytics partner, DataGen, about payment innovation and clinical transformation. Download Now

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