Page 24 - 2020 Annual Outcomes Report
P. 24

 VALUE
LINKING QUALITY TO PAYMENT
In the shift from fee-for-service to value-based care, Hoag Orthopedic Institute has been a national leader by pioneering and implementing meaningful value-based initiatives and programs that optimize patient outcomes while minimizing cost.
CMS deployed an array of payment innovation programs to reward hospitals for delivering services of higher quality and higher value. HOI participates in three Mandatory Programs.
Hospital Readmission Reduction Program
(see page 12)
HOI participates in the Hospital Readmissions Reduction Program through Medicare that reduces up to 3% hospital inpatient Medicare payment to hospitals with excess readmission.
HOI has not received any payment reduction due to excess readmission. In fact, HOI has the lowest readmission rate in California (out of 317 hospitals) and the 4th lowest readmission rate in the nation (out of 4,470 hospitals).
Hospital-Acquired Condition Reduction Program (see page 13-14)
The Hospital-Acquired Condition Reduction Program reduces payment to hospitals that
rank among the lowest-performing 25 percent. Penalty is based on performance in 2 domains: patient safety (PSI 90) and healthcare-associated infections. HOI has not received payment reduction due to hospital acquired conditions.
Comprehensive Care for Joint Replacement Program (CJR)
The CJR tests bundled payment and quality measurement for an episode of care associated with lower extremity joint replacements 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. HOI consistently received “Excellent” quality scores.
HOI’s mandatory participation in CJR began in 2016. This bundled program is a retrospective, two-sided, risk-sharing care delivery payment model with the hospital bearing the financial responsibility. The episode of care includes hospitalization and the 90-day post-hospital discharge time period for complications and payment analysis for lower extremity joint replacement.
CJR Overall Volume
1,500
1,000
597
PY1 PY2
1,354
     500
0
1,227
1,124
   22 | HOAG ORTHOPEDIC INSTITUTE
Source: HOI Internal Data
PY3 PY4








































































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