In accordance with the CJR Final Regulation, St. Clair Hospital is allowed to partner with surgeons (“Collaborators”) and enter into a financial arrangement in which St. Clair Hospital will share any savings as a result of care redesign efforts initiated as part of the CJR Model with Collaborators who have signed an agreement with the Hospital. St. Clair Hospital surgeons who accept traditional fee-for-service Medicare and perform major lower extremity joint procedures may partner with St. Clair Hospital in the CJR Model. Surgeons will be required to sign a CJR Collaborator Agreement with St. Clair Hospital and adhere to the contents of the agreement in terms of care redesign and quality criteria. Quality criteria are established by St. Clair Hospital and will be tied to the methodology in which incentive payments are distributed to Collaborators. If savings are achieved under the CJR Model, incentive payments will be derived from the Net Payment Reconciliation Amount (NPRA).
Any St. Clair Hospital credentialed surgeon who has not opted-out of Medicare, is in “good standing” status with Medicare and compliant with all Medicare provider enrollment requirements, accepts traditional fee-for-service Medicare, and performs major lower extremity joint replacement procedures (DRGs 469 and 470) at St. Clair Hospital will be eligible to enter into a financial arrangement with St. Clair Hospital as a Collaborator under the Medicare CJR model.
Surgeon collaborators must sign a “Comprehensive Joint Replacement Program Collaborator Agreement” with St. Clair Hospital, agreeing to adhere to the care redesign initiatives, compliance and program requirements, quality metrics and gainsharing methodologies. In addition to the requirements outlined in the Collaborator Agreement, surgeons must agree to distribute the required beneficiary notification to patients at the time surgery is scheduled and must not object to their information being disclosed on the Hospital’s website as being a Collaborator.