Comprehensive Care for Joint Replacement (CJR)
Orlando Health South Seminole 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.
Selection Criteria for Collaborators
General Provider and Supplier Collaborators (including Physicians). Orlando Health South Seminole Hospital will select CJR collaborators in a manner consistent with the CJR Rule and based on quality performance criteria and participation in care redesign (i.e., collaborators will be required to participate actively in care redesign for improving and enhancing the care and management of care for beneficiaries in a CJR episode). The selection criteria shall not be based directly or indirectly on the volume or value of referrals or business otherwise generated by, between or among Orlando Health South Seminole Hospital, CJR collaborators, and any individual or entity affiliated with Orlando Health South Seminole Hospital or CJR collaborator. Any collaborator selected for participation in the CJR Program must execute a collaborator agreement with Orlando Health South Seminole Hospital setting forth the applicable elements of the CJR Program and the sharing arrangement in order to be eligible for gainsharing payments.
Physician Collaborators Additional Requirements. For physician collaborators, the selection criteria for participation in the CJR Program shall include the following requirements:
• Collaborator must be an active member of the medical staff in good standing;
• Collaborator must hold clinical privileges to perform episode based procedures in the CJR Program (DRG 469 and 470) as may be amended from time to time by CMS
• Collaborator must be a participating provider in the Medicare program;
• Collaborator must be in compliance with all Medicare provider enrollment requirements (set forth at 42 C.F.R. Sections 424.500 et seq.);
• Collaborator must have executed a physician collaborator agreement with Orlando Health South Seminole Hospital and not be in breach of such agreement or any representation and warranty made in such agreement;
• Collaborator must agree to participate in care redesign activities related to the CJR Program;
• Collaborator must have and maintain a valid and active tax identification number and NPI;
• Additional selection criteria may be approved by the Committee. The selection criteria for physician collaborators shall not be based directly or indirectly on the volume or value of referrals or business otherwise generated between Orlando Health South Seminole Hospital and such collaborator physicians;
Collaborator must not be excluded from participating in Medicare, Medicaid, or any other federal healthcare program, as defined at 42 U.S.C. Section 1320a-7b(f).