JFK Health Engages PMMC for CJR Bundled Payment Analytics

October 18, 2016

PMMC, a leading revenue cycle management company, was selected by JFK Health for bundled payments analytics to manage the costs for the Comprehensive Care for Joint Replacement (CJR) Model.

PMMC, a leading revenue cycle management company, was selected by JFK Health for bundled payments analytics to manage the costs for the Comprehensive Care for Joint Replacement (CJR) Model.

JFK Health, a non-profit health organization based in Edison, NJ, is located in one of the metropolitan statistical areas required to participate in CJR – meaning the hospital is accountable for managing the episode costs for hip and knee replacements across the entire continuum of care.

PMMC is providing JFK with powerful analytics and predictive modeling so the organization can quickly evaluate performance in the CJR program and make the necessary adjustments with post-acute care (PAC) Providers in order to earn a repayment from Centers for Medicaid and Medicaid Services (CMS) for managing costs below the target price.

“We need to be able to react quickly and PMMC’s analytics enables us to do that,” said the Director of Managed Care at JFK. “The data provided by CMS is difficult to analyze and does not allow us to make business decisions quickly enough.”

With PMMC Online Analytics, JFK can easily compare its own costs for the entire episode to CMS targets – as well as internal benchmarks – on a quarterly basis. The organization has set a goal of earning a repayment from CMS when payments are reconciled at the end of the first year of the program.

In addition to the benchmark data, JFK will use predictive modeling to more effectively manage its patient care pathways. This is a customized approach that allows JFK to model different scenarios across the continuum of care to identify the most cost effective clinical pathway while maintaining a high quality of care.

“Predictive modeling is not a ‘cookie-cutter’ approach and is truly a customized solution for us,” added the Director of Managed Care.

Internally, the health system has taken the necessary steps to ensure success in CJR by establishing a steering committee to lead the strategy and setting up controls to track costs.Additionally, JFK has engaged and collaborated with its physicians to gain buy-in for becoming a “center of excellence” in joint replacement.

The combination of internal strategy and collaboration with external data will standardize the entire process and position JFK to succeed in the CJR program.

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About PMMC

PMMC provides high value revenue cycle software and services to improve the financial performance of healthcare organizations. PMMC’s unique combination of software with 30 years of revenue cycle expertise reveals greater financial accuracy and missed revenue opportunities in the areas of underpayments and denials, pricing transparency, and value-based reimbursement – resulting in a 10 to 1 client return on investment.

About JFK Health

JFK Medical Center, an affiliate of JFK Health, is a 498-bed full-service, acute care hospital, and the adjacent JFK Johnson Rehabilitative Institute. Located in the heart of Edison, NJ, it has remained at the forefront of quality care in the region since its inception in 1967. Today, JFK accommodates more than 20,000 admissions, 3,000 births and 60,000 Emergency Room visits on a yearly basis. The Medical Center features a complete array of services, including general surgery, emergency medicine, mental health, orthopedics, maternity and pediatric care. It is home to two world renowned institutes: the JFK Neuroscience Institute and the JFK Johnson Rehabilitation Institute, as well as JFK Haven Hospice, JFK Imaging Center and the Center for Wound Healing.

JFK Medical Center is proud to be rated the #1 stroke program in New Jersey and in the top 5% in the entire country. With a Gold Plus award for stroke care by the American Heart Association and a comprehensive and primary stroke center designation, our neuroscience program is unmatched with both neurological and rehabilitation services.