Medicare’s Comprehensive Care for Joint Replacement (CJR) Model introduced a new measurement for joint replacement programs, the Composite Quality Score. How this score is calculated is a bit complicated, so here’s a breakdown of how it works:
The CJR Composite Quality Score is a score between 0 and 20 and is made up of 3 parts:
- Hip/Knee Complications – this risk-standardized complication rate is already published on the CMS Hospital Compare website
- HCAHPS Survey Measure – this is the patient satisfaction rating for the hospital as a whole (not just ortho patients)
- PRO Submission – this is a process measure if a hospital has collected and submitted required patient-reported outcomes data
The complication rate is weighted most heavily at 50% or 10 out of the 20 possible points. HCAHPS is next with 40% of the score or up to 8 points. PRO submission is 10% of the score with 2 points.
Now let’s look at how each part of the score is calculated:
Hip/Knee Complications – CMS takes the publicly reported risk-standardized complication rate and grades your program on a curve against all other hospitals in the nation. The hospitals are broken up into performance deciles, based on which decile you fall into, you get the number of points delineated in the table below.
HCAHPS Survey – For this part, CMS takes an average across 10 of the 11 patient experience survey questions. (They decided to exclude the pain management question.) The averaged score for HCAHPS is then again graded on a curve against all the other hospitals across the country. Performance is broken into deciles, and based on which decile you fall into, you get the number of points in the table below.
PRO Collection – This is basically a yes or no measurement. If you submit the minimum number of patient-reported outcomes data entries through the CJR web portal by the deadline you get 2 points. If you do not get the minimum amount of data in by the deadline, you get 0 points.
The points from all 3 measurements are added together. Then you can see which quality category you fall in according to the table below.
- A Below Acceptable rating means you are ineligible to receive any reconciliation dollars and are facing the maximum Medicare penalty of 3% on all your elective joint replacement episodes.
- An Acceptable rating means you are eligible to receive reconciliation dollars, but are still facing the maximum Medicare penalty of 3% on all your elective joint replacement episodes.
- A Good rating means you are eligible to receive reconciliation dollars and your penalty is reduced to 2%.
- An Excellent rating means you are eligible to receive reconciliation dollars and your penalty is reduced to 1.5%.
In subsequent years, Medicare can also award improvement points for those hospitals who make two-decile jumps in either category. Improvement points for eligible hospitals equal 1 point for Complications and 0.8 points for HCAHPS.
This data is expected to be publicly reported for CJR hospitals on the Hospital Compare website in July. However, data analysts at Wellbe have calculated an estimated CJR composite quality score for every hospital in the nation, regardless if they are in the CJR program or not. To request a copy of your hospital’s free CJR Quality Score estimate, just email firstname.lastname@example.org.
(Reference tables take from CMS fact sheet here.)