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Event Details

Location: Online
Cost: Free
Hosted By: Fredrikson's Health Law Group

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On April 1st, 2016, in 67 Metropolitan areas, Medicare changed the way it pays for joint replacement procedures with DRG 469 or 470 in prospective payment hospitals. While the new payment methodology only applied in 67 areas, (to see if your area was included, click here), the program was likely to have an impact across the country. Under the program, Medicare established a target price for an episode of care that begins when the patient is admitted to the hospital and ends 90 days following the patient’s discharge. The hospital would be responsible for managing costs to meet the target price. If the costs exceed the target, the hospital must repay Medicare. If the costs are lower than the target, the hospital receives a payment from Medicare. Additionally, quality criteria can increase or decrease the payment. Hospitals are permitted, but not required, to share risk with other entities providing care during the 90-day window.

This webinar gave an overview of the CJR program. While the session did not go into mathematical detail about how the payments or quality metrics are calculated, it did provide a sense of how the program works, and explore possible implications for hospitals, physicians, therapists and SNFs both in the MSAs covered by the program and in the rest of the country. We also discussed gainsharing; how it can be used as part of CJR and how hospitals and physicians can use gainsharing in other parts of the country.


We have applied for Continuing Legal Education (CLE) credit for this program in Iowa and Minnesota. Please contact Greta Larson at if you are an attorney licensed in another state and would like information about obtaining CLE accreditation. We have also applied for Health Care Compliance Association (HCCA) credits. Webinar participants will be notified of accreditation upon program approval of CLE and HCCA credits (typically three or four weeks following the webinar).

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