Report: CJR model reduces episode payments 

Sep 10, 2018 - 02:46 PM

Hospitals participating in the first year of Medicare’s Comprehensive Care for Joint Replacement Model reduced payments for lower extremity joint replacement episodes by an average 3.3 percent more than hospitals that did not participate in the model, largely by shifting patients to less intensive post-acute care settings, according to an analysis prepared for the Centers for Medicare & Medicaid Services by the Lewin Group. For example, the share of CJR patients discharged to an inpatient rehabilitation facility fell by a relative 2.2 percentage points while the share discharged to a home health agency rose by 3.9 percentage points. The study found no changes in quality of care as measured by readmission rates, emergency department visits and mortality. CMS implemented the five-year payment model, which qualifies as an advanced alternative payment model under the Quality Payment Program for clinicians, in certain geographic areas in April 2016. The first-year report does not include estimates of the change in Medicare program savings, which were not yet available. 
 

Related News Articles

Headline
CMS launches payment model for state Medicaid programs to purchase drugs at most-favored-nation pricing
The Centers for Medicare & Medicaid Services is launching a new initiative for state Medicaid programs to purchase prescription drugs at prices aligned…
Headline
AHA comments on CY 2026 physician fee schedule final rule 
The AHA commented Nov. 3 on the Centers for Medicare & Medicaid Services’ calendar year 2026 final rule for the physician fee schedule. The rule, released…
Headline
CMS issues CY 2026 physician fee schedule final rule
The Centers for Medicare & Medicaid Services Oct. 31 released its calendar year 2026 final rule for the physician fee schedule. As required by law,…
Headline
CMS releases guide on prior authorization submissions, determinations under WISeR model  
The Centers for Medicare & Medicaid Services has released an operational guide for Medicare-enrolled providers and suppliers on the Wasteful and…
Headline
CMS lifts claims hold on PFS, other claims amid government shutdown
The Centers for Medicare & Medicaid Services Oct. 21 announced that it has instructed all Medicare Administrative Contractors to lift a hold and begin…
Headline
Medicare open enrollment for 2026 begins
Medicare open enrollment for 2026 began Oct. 15 and runs through Dec. 7. During the annual enrollment period, Medicare-eligible individuals can check their…