PMMC Clients Finish in Top 10 Percent of Hospitals in First Year of CJR Program

October 25, 2017 

PMMC clients received average reconciliation payment of $178,000 – 80% higher than national average

Healthcare providers partnering with PMMC, a leading revenue cycle company, finished in the top 10 percent of all hospitals in the Comprehensive Care for Joint Replacement (CJR) program and received a higher financial incentive than the average participating hospital, according to the first year preliminary results announced by CMS.

The “winners list” – those healthcare providers that finished below the spend target and received a reconciliation payment from CMS – included 382 hospitals out of about 800 total in the mandatory program.

The average reconciliation payment among those that received it was $1198 per episode and $98,000 per hospital. PMMC clients fared significantly better – averaging $1445 per episode (21% higher than the average) and $178,000 per hospital (81% higher than average).

“It’s no surprise that the healthcare providers who came out ahead in this program had strong internal leadership, identified cost savings opportunities early in the process, and took a proactive approach to engage their physicians and other post-acute care collaborators,” said Tara Bogart, Vice President of Consulting at PMMC.

“CJR and other bundled payments programs are among the very few efforts showing significant large-scale improvements in quality of care while simultaneously reducing the overall cost.  “We’re hopeful that we will see more leading organizations becoming proactive with these Value Based Purchasing models,” states Roger Shaul, PMMC’s President.

PMMC provided its clients with actionable analytics to quickly evaluate spend performance among its post-acute care (PAC) providers and pinpoint the cost savings opportunities. A strategy was then developed to build collaboration among the hospital and its physicians.

To help build this collaboration strategy, PMMC consulted with hospital physicians to gain buy-in to the program. By presenting a transparent, third-party perspective supported by data, physicians responded positively to hospital leadership.

Additional PAC process improvements among PMMC clients included:

- 64% decrease in inpatient rehab cases
- 56% decrease in inpatient readmissions
- 41% decrease in length-of-stay

About PMMC

PMMC provides high value revenue cycle software and services to improve the financial performance of healthcare organizations. Our software and expertise focuses on payment accuracy and identifying more revenue opportunities across the revenue cycle.

PMMC helps hospitals identify underpayments and denials, increase price transparency, and manage bundled payments. Clients see, on average, a 12 to 1 return on investment with software and services. For more information, visit www.PMMConline.com.