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CMS Proposes Extension, Changes to Joint Model

On Feb. 20, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to extend the length of the Comprehensive Care for Joint Replacement (CJR) model and revise other aspects of the model.

The CJR model is a five-year demonstration that began April 1, 2016, and is scheduled to end Dec. 31, 2020. The model aims to reduce expenditures while preserving care quality for beneficiaries undergoing hip and knee replacements.

The proposed rule would extend the length of the CJR model for an additional three years, through December 31, 2023, for hospitals in the 34 mandatory metropolitan statistical areas. Additionally, CMS proposes to include outpatient knee and hip replacement in the definition of a CJR episode, in response to changes to the inpatient-only list that now allows for total knee and hip replacements to be treated in the outpatient setting. As proposed, CMS would establish a site-neutral bundle and group outpatient procedures with the least complicated inpatient total knee and hip replacements for establishing target prices.

CJR target price calculation proposals include changing the basis for the target price to the most recent one year of claims data (currently three years) and incorporating additional risk adjustment (beyond fracture status) based on the individual beneficiary’s age and hierarchical condition category (HCC) condition count.

CMS also seeks comment on the design of a future bundled payment model for joint replacements performed in the ambulatory surgical center setting.

Comments on the proposed rule are due to CMS by April 24.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Maryellen Guinan is a senior policy analyst at America's Essential Hospitals.

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