February 27, 2020

CMS Proposes Rule Extending and Changing Comprehensive Care for Joint Replacement Model

On February 20, CMS issued a proposed rule extending the Comprehensive Care for Joint Replacement (CJR) model into 2023, changing the definition of “episode,” and changing the CJR target price calculation. The CJR model was established five years ago in an effort to “reduce Medicare expenditures while preserving or enhancing quality of care for Medicare beneficiaries” by paying participant hospitals retrospective, bundled payments for “episodes of care for lower extremity joint replacement or reattachment of a lower extremity.” The proposed rule retains the same goal but makes several changes to improve the model, better recognize high quality care, and better capture changes in program payment updates and care delivery patterns. CMS proposes to 1) change “episode” to include outpatient knee and hip replacement; 2) make several changes to the CJR target price calculation and CJR reconciliation process; 3)change the high episode spending cap calculation methodology used at reconciliation; and 4) make changes to the beneficiary notification, gainsharing caps, appeals process, and waiver sections to conform with changes to the proposed model extension and episode definition.