Special Bulletin: CMS Proposes Changes to Hip and Knee Bundled Payment Program

The Centers for Medicare & Medicaid Services (CMS) Feb. 20 issued a rule proposing changes to the Comprehensive Care for Joint Replacement (CJR) model, which bundles payment to acute care hospitals for hip and knee replacement surgery. Under this model, hospitals in which a joint replacement has taken place are held financially accountable for episode quality and costs.

Among other proposals, CMS would extend the CJR model for an additional three years, through Dec. 31, 2023, beyond its current five-year timeline. However, this extension would apply only to hospitals in the 34 metropolitan statistical areas (MSAs) in which participation was mandatory. Hospitals participating in the 33 “voluntary” MSAs, as well as all low-volume and rural hospitals that have elected to participate, will continue to see the model end on Dec. 31, 2020.

AHA Take:
The AHA has long been supportive of voluntary participation in alternative payment models as a pathway to potentially improve care coordination and efficiency. As such, we are disappointed that CMS is not proposing to extend voluntary participation options in the CJR model.

Key Takeaways

• CMS proposes to extend the CJR model for an additional three years, through Dec. 31, 2023.
• This extension would apply only to hospitals participating on a mandatory basis.
• CMS would add outpatient procedures to the CJR model, and, as a result, add additional risk adjustment as well.
• The agency proposes to increase shared savings thresholds to hospitals with higher quality scores.
• CMS would use one year of data — the most recent available — to set hospital pricing targets as compared to the current three years of data.
• CMS proposes to retain the same quality measures for the extension of the model.
• The proposed rule will be published in the Feb. 24 Federal Register, and CMS will accept comments for 60 days after it is published.

A summary with highlights of the proposed rule follows under key resources