The U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) has finalized the Comprehensive Care for Joint Replacement (CJR) model, to begin on April 1, 2016 (rather than January 1, 2016 in CMS’ proposed rule). The CJR model will test bundled payment and quality measurement for hip and knee replacements and/or major leg procedures to encourage hospitals, physicians, and post-acute care providers to work together to improve quality and coordination of care throughout an entire episode of care, from the initial hospitalization through recovery.
By holding participant hospitals accountable for episode spending and quality associated with services included in CJR episodes, hospitals will be encouraged to carefully consider the needs of each individual patient. Given this financial and quality responsibility, CMS anticipates providers will be motivated to engage in a number of quality improvements, such as better care coordination and improved care transitions between medical settings that result in better outcomes for Medicare beneficiaries. CMS will implement the proposed model in 67 geographic areas, defined by metropolitan statistical areas (MSAs). MSAs are counties associated with a core urban area that has a population of at least 50,000. The CMS program website has a list of the 67 MSAs. Approximately 800 hospitals in the 67 MSAs are required to participate in the CJR model. Hospitals outside the selected geographic areas are not able to participate. There is no application process for this model.
The CJR model has been designed by the CMS Innovation Center, which was established by section 1115A of the Social Security Act as amended by section 3021 of the Affordable Care Act. Congress created the CMS Innovation Center to test innovative payment and service delivery models to reduce CMS program expenditures and improve quality for CMS beneficiaries. The final rule will be published in the Federal Register on November 24, 2015. Below is a pre-publication version of the final rule.
Ignatius Bau 