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

Related Resources

Letter/Comment
Public
In a letter to CMS Administrator Seema Verma regarding the expansion of Medicare’s accelerated payment program and creation of an add-on payment for Medicare…
Letter/Comment
Public
Dear Secretary Azar, Ms. Verma and Ms. Chiedi: On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our…
Letter/Comment
Public
The AHA submitted its comments to the Office of Management and Budget regarding the Centers for Medicare & Medicaid Services (CMS) plans to collect pricing…
Letter/Comment
Public
The AHA March 5 expressed support for legislation (S. 3399) to extend for five additional years the Frontier Community Health Integration Project (FCHIP)…
Letter/Comment
Public
The AHA urges the Department of Health and Human Services to take a number of regulatory actions that would help hospitals and health systems better…
Advisory
Member
At Issue: The Department of Homeland Security (DHS) on Feb. 24 began implementing new standards for immigration public charge decisions. When making certain…