On Thursday, February 20, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (February 24 Federal Register publication) to extend the Comprehensive Care for Joint Replacement (CJR) Model for an additional three years in order to better evaluate the program. CMS states in the proposed rule that participating hospitals in the CJR model saw the average episode of care payments decrease by $997 more than non-participating hospitals. CMS estimates that the changes proposed would create an additional $269 million in savings for the government.
The CJR model was established in a 2015 final rule. It was the first mandatory model when it began on April 1, 2016, and for the first two performance years, 800 hospitals in 67 U.S. regions were required to participate. However, in December of 2017, CMS issued a final rule that made the program voluntary for 33 of the participating 67 regions. The CJR Model “tests bundled payment and quality measurement for an episode of care associated with hip and knee replacements to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery.”
Currently, an episode of care begins when a Medicare beneficiary is admitted to a participant hospital for MS-DRG 469 (Major joint replacement or reattachment of lower extremity with major complications or comorbidities) or 470 (Major joint replacement or reattachment of lower extremity without major complications or comorbidities) and covers all related care under Medicare Parts A and B within 90 days following discharge. A hospital is held accountable for the cost and quality during an episode of care. CMS proposes to change the definition of an episode of care under the CJR model to include outpatient knee and hip replacements and base the target prices on the most recent year of claims data, instead of using three years of claims data.
In order to continue to evaluate the CJR model, the February 20, 2020 rulemaking proposes extending the CJR model, which was slated to end at the end of 2020, for an additional three years, or through December 31, 2023. CMS also proposes to implement a single reconciliation period six months after the close of the performance year. Presently, there are two reconciliations, two months and fourteen months after the performance year. Concurrently with the proposed rule CMS released a fact sheet, which is available here.
Public comments on the proposed rule must be submitted to CMS no later than 5 pm EST on April 24, 2020. Comments may be submitted electronically to www.regulations.gov, or by regular mail to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-5529-P, P.O. Box 8013, Baltimore, MD 21244-1850.