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Comprehensive Care for Joint Replacement

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Northeast Georgia Medical Center is participating in a New Care Improvement Initiative from Medicare

Northeast Georgia 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. Northeast Georgia Medical Center’s participation in the CJR model should not restrict your access to care for your medical condition or your freedom to choose your health care providers and services. All existing Medicare beneficiary protections continue to be available to you. These include the ability to report concerns of substandard care to Quality Improvement Organizations and 1-800-MEDICARE.

The CJR model aims to help give you better care.

The CJR model aims to support better and more efficient care for beneficiaries undergoing LEJR procedures. A CJR episode of care is typically defined as an admission of an eligible Medicare beneficiary to a hospital participating in the CJR model that eventually results in a discharge paid under Medicare Severity-Diagnosis Related Groups (MS-DRG) 469 (major joint replacement or reattachment of lower extremity with major complications or comorbidities) or 470 (major joint replacement or reattachment of lower extremity without major complications or comorbidities). The CJR episode of care continues for 90 days following discharge. This model tests bundled payment and quality measurement for an episode of care associated with LEJR procedures to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery. Through this bundled payment model, Northeast Georgia Medical Center will receive additional payments if quality and spending performance are strong or, if not, potentially have to repay Medicare for a portion of the spending for care surrounding a lower extremity joint replacement procedure.

Medicare is using the CJR model to encourage Northeast Georgia Medical Center to work more closely with your doctors and other health care providers that help patients recover after discharge from the hospital, including nursing homes (skilled nursing facilities), home health agencies, inpatient rehabilitation facilities, and long-term care hospitals. The goal of the model is to encourage these providers and suppliers to provide you with better, more coordinated care during and following your hospital stay. The model is expected to lower the cost of care to Medicare but your costs for covered care will not increase due to these changes.

Northeast Georgia Medical Center is working closely with the doctors and other health care providers and suppliers who will care for you during and following your hospital stay and extending through the recovery period. By working together, your health care providers and suppliers are planning more efficient, high quality care as you undergo treatment.

Medicare will monitor your care to ensure you and others are receiving high quality care.

Northeast Georgia Medical Center entered into financial arrangements with collaborating health care providers and suppliers who are engaged in care redesign with the hospital and who may furnish health care services to you during your episode of care. Under these agreements, Northeast Georgia Medical Center may share payments received from Medicare as a result of reduced episode spending and hospital internal cost savings with collaborating providers and suppliers. Northeast Georgia Medical Center may also share financial accountability for increased episode spending with collaborating providers and suppliers.

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

Ortho TLC at The Longstreet Clinic

www.longstreetclinic.com/orthopaedics/orthopaedics-sports-medicine

Amy Borrow, MD
Harry Ferran, Jr., MD
Stephen R. Fisher, MD
Michael B. Gottsman, MD
Derek Ronald Moore, MD
Barry G. Munn, MD

Gainesville Office:
725 Jesse Jewell Parkway
Gainesville, GA 30501
Phone: (770) 718-1122

Specialty Clinics of Georgia - Orthopedics, PC

www.scg-ortho.com

John Vachtsevanos, MD
W. David Weiss, MD
Gary Davis, III, MD
Kris Wheeler, MD
C. Cullen Scott, MD
Filippo Chillemi, MD
John Hemmer, MD
Benjamin Puckett, MD

Gainesville Office:
1240 Jesse Jewell Parkway
Suite 300
Gainesville, GA 30501
Phone: (770) 532-7202

Braselton Office:
1241 Friendship Road
Suite 110
Braselton, GA 30517
Phone: (770) 532-7202  

NGPG Orthopedic Surgery & Sports Medicine                

www.ngpg.org/orthopedics 

Mark Hazel, MD
Darrell K. Scales, MD
Robert M. Wood, MD
Gregory Woods, MD

Braselton Office:
1404 River Place
Braselton, GA 30517
Phone: (770) 848-6190

NGPG Trauma & Acute Care Orthopaedic Surgery

http://www.nghs.com/trauma-acute-care-orthopaedic-surgery-tacos

Brandon Bruce, MD
Greg Herzog, MD
Fernando H. Serna, MD

Gainesville Office:
1315 Jesse Jewell Parkway NE
Gainesville, GA  30501

Additionally, the following website, www.nghs.com/orthopaedics, includes this list of health care providers and suppliers that have established a collaborator agreement with Northeast Georgia Medical Center.

It’s your choice which hospital, doctor, or other providers you use.

You have the right to choose which hospital, doctor, or other post-hospital stay health care provider you use.

  • To find a different doctor, visit Medicare’s Physician Compare website, http://www.medicare.gov/physiciancompare, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  • To find a different hospital, visit http://www.hospitalcompare.hhs.gov/ or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  • To find a different skilled nursing facility, visit Medicare’s Nursing Home Compare website, http://www.medicare.gov/nursinghomecompare, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  • To find a different home health agency, visit Medicare’s Home Health Agency Compare website, http://www.medicare.gov/homehealthcompare, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  • If you believe that your care is adversely affected or have concerns about substandard care, you may call 1-800-MEDICARE or contact your state’s Quality Improvement Organization by going to: http://www.qioprogram.org/contact-zones.

For an explanation of how patients can access their health care records and beneficiary claims data, please visit https://www.healthit.gov/patients-families/blue-button/about-blue-button.

Get more information

If you have questions or want more information about the Comprehensive Care for Joint Replacement (CJR) model, call Northeast Georgia Medical Center at (770) 219-5257 or call 1-800-MEDICARE. You can also find additional information at https://innovation.cms.gov/initiatives/cjr.

The Beneficiary Notice Applies to Patients Having Medicare Part A and B as Their Primary Insurance.

NGMC 208811-03130 A (7/1/17)

 

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