Comprehensive Care

Coral Gables Hospital is participating in a Medicare initiative called the Comprehensive Care for Joint Replacement (CJR) model. The CJR model aims to promote quality and financial accountability for care surrounding lower-extremity joint replacement (LEJR) procedures, commonly referred to as hip and knee replacements and/or other major leg procedures.

The following list includes health care providers and suppliers that have established a collaborator agreement with Coral Gables Hospital in order to share in financial rewards and/or losses in the CJR model.

Current Collaborators:
N/A
Past Collaborators:
N/A

If you have questions or want more information about the Comprehensive Care for Joint Replacement (CJR) model, call Steward Coral Gables Hospital’s at 305-445-8461 or call 1-800-MEDICARE. 

Comprehensive Care for Joint Replacement (CJR) Program Collaborator Selection Policy

Effective Date: 4/1/2016

Coral Gables Hospital, designated by the Centers for Medicare and Medicaid Services (CMS) to participate in the CMS CJR program, maintains written policies for selecting providers and suppliers for sharing risk and gains as CJR collaborators as follows:

1. Policy:

   CJR Collaborator selection shall be made in accordance with all relevant laws and regulations, including the applicable fraud and abuse laws and all applicable payment and coverage requirements as defined for the CMS CJR program. Selection criteria are not based directly or indirectly on the volume or value of referrals or business otherwise generated by, between, or among the hospital, CJR collaborator, and any individual or entity affiliated with the hospital or CJR collaborator. 

2. Definitions:

   CJR activities means activities related to promoting accountability for the quality, cost, and overall care for CJR beneficiaries, including managing and coordinating care; encouraging investment in infrastructure enabling technologies and redesigned care processes for high quality and efficient service delivery; the provision of items and services during a CJR episode in a manner that reduces costs and improves quality; or carrying out any other obligation or duty under CJR.

   CJR collaborator means one of the following Medicare-enrolled persons or entities that enters into a sharing arrangement:
   (1) Skilled nursing facility (SNF); (2) Home health agency (HHA); (3) Long-term care hospital (LTCH); (4) Inpatient rehabilitation facility (IRF); (5) Physician; (6) Nonphysician practitioner; (7) Therapist in private practice; (8)  Comprehensive Outpatient Rehabilitation Facility (CORF); (9)  Provider of outpatient therapy services; (10)  Physician Group Practice (PGP); (11)  Hospital; (12) Critical Access Hospital (CAH); (13) Non-Physician Provider Group Practice (NPPGP); (14) Therapy Group Practice (TGP); (15) Accountable Care Organization (ACO) 

3. Criteria:
   1. Privileged to perform a surgical procedure in MS DRGs 469, 470, 480, 481, 482
   2. Eligible to participate in Medicare
   3. Commitment to participate in CJR activities, including:
      1. Attends 75% of Care Redesign Workgroup meetings
      2. Attends Quarterly Data Review meetings
      3. Notifies hospital facility designee of at least 80% of elective CJR admissions at least 14 days in advance in a mutually determined format