Northeast Georgia Medical Center is participating in Medicare’s Comprehensive Care for Joint Replacement (CJR) model
Northeast Georgia Medical Center is participating in the Comprehensive Care for Joint Replacement (CJR) model. Medicare designed this model to encourage higher quality care and greater financial accountability from hospitals when Medicare beneficiaries receive lower-extremity joint replacement procedures (LEJR), typically hip or knee replacements. 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.
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 for an LEJR procedure. The LEJR procedure can take place in either an inpatient or outpatient setting and will still be considered a CJR episode of care. The CJR episode of care continues for 90 days following discharge.
This model uses episode 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. Under the CJR model, Northeast Georgia Medical Center can earn additional payments from Medicare if we meet the high quality goals set by Medicare, while keeping hospital costs and care spending under control. If we don’t meet these quality and cost goals, we may have to repay Medicare.
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, but not limited to, nursing homes (skilled nursing facilities), home health agencies, inpatient rehabilitation facilities, and long- term care hospitals. If you require a stay in a Skilled Nursing Facility (SNF) to assist with your recovery from surgery and if, and only if, it is clinically appropriate, the CJR model permits Northeast Georgia Medical Center to discharge you to a high quality SNF sooner than the three days Medicare usually requires to cover a SNF stay.
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 arrangements, 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 financial arrangement with Northeast Georgia Medical Center in order to share in financial rewards and/or losses in the CJR model:
Longstreet Clinic Orthopedics
- Derek Ronald Moore, MD
- Barry G. Munn, MD
Specialty Clinics of Georgia – Orthopedics, PC
- John Vachtsevanos, MD
- W. David Weiss, MD
- Gary Davis, III, MD
- C. Cullen Scott, MD
- Filippo Chillemi, MD
NGPG Orthopedic Surgery & Sports Medicine
- Darrell Scales, MD
- Shan Sharif, MD
- Gregory Woods, MD
NGPG Orthopedic Trauma & Reconstructive Surgery
- Brandon Bruce, MD
- Greg Herzog, MD
- Fernando H. Serna, MD
Additionally, the following website, https://www.nghs.com/orthopedics/comprehensive-care-for-joint-replacement, includes this list of health care providers and suppliers that have established a financial arrangement 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.
- 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.
- 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 https://www.medicare.gov/hospitalcompare, 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.
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 770-219-9000 or call 1-800-MEDICARE. You can also find additional information at https://innovation.cms.gov/initiatives/cjr.