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CMS finalizes Comprehensive Care for Joint Replacement Model

The Centers for Medicare & Medicaid Services (CMS) recently finalized the Comprehensive Care for Joint Replacement (CJR) model.  This 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.

The CJR Model includes the following:

  • Start Date: In order to allow participant hospitals more time to prepare, the first performance period for the model will begin on April 1, 2016 instead of the proposed January 1, 2016 performance period start date.
  • Site Selection: The CJR Model will be implemented in 67 metropolitan statistical areas (MSAs), instead of the proposed 75 MSAs, to respond to comments asking for us to incorporate the increased participation in the Bundled Payments for Care Improvement (BPCI) initiative since publication of the proposed rule and to incorporate BPCI physician group practice participation levels into our MSA selection methodology.
  • Quality Measures in Model Pay-for-Performance: CMS is finalizing an alternative, composite quality score methodology, rather than the threshold methodology that we proposed, in order to provide stronger incentives for more hospitals to improve quality.
  • Payment: In response to several commenters requesting a more gradual transition to downside risk and a lower stop-loss limit to allow hospitals more time to gain experience under the CJR model, CMS is finalizing a policy for no repayment responsibility in performance year 1, a stop-loss limit of 5 percent in performance year 2, a stop-loss limit of 10 percent in performance year 3, and a stop-loss limit of 20 percent in performance years 4 and 5 for participating hospitals other than rural hospitals, Medicare-dependent hospitals, rural referral centers, and sole community hospitals. A parallel approach has been finalized for the stop-gain limits to provide proportionately similar protections to CMS and hospital participants, as well as to protect the health of beneficiaries. We are also gradually phasing in repayment responsibility with a reduced discount percentage for repayment responsibility in years 2 and 3.
  • Waivers: No waivers of any fraud and abuse authorities are being issued in the final rule. Rather, CMS and OIG will jointly issue a notice regarding the waiver of certain fraud and abuse laws for purposes of testing this model. The notice will be published on the CMS and OIG websites.

For more information about the CJR model please click HERE.

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