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Analysis

CMS Proposes Three-Year Extension to Joint Replacement Model

By Jack O'Brien  
   February 21, 2020

In addition to the extension, CMS included episode definition and pricing changes in the proposed rule.

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule Thursday to extend the Comprehensive Care for Joint Replacement (CJR) Model by three years.

CMS has proposed an extension of the CJR Model, which was launched in 2016 and is slated to lapse at the end of 2020, in order to "allow time to evaluate the proposed changes."

In addition to the extension, CMS included episode definition and pricing changes in the proposed rule.

Related: Urinary Catheter Not Needed for Joint Replacement Surgeries

These changes include adding outpatient hip and knee replacements into the episode of care definition, as well as the target price calculation and reconciliation process, among other requirements.

"We are proposing this episode definition change in order to address changes to the inpatient-only (IPO) list that now allow for total knee and total hip replacements to be treated in the outpatient setting," CMS stated in a fact sheet. "Additionally, the rule proposes changes to the CJR target price calculation."

The full text of the proposed rule was filed on Thursday and will be published on the Federal Register on February 24.

Related: Older Adults With Joint Replacements Recover At Home, Not Rehab

Recent research has pointed to the effectiveness of mandatory bundled payments at hospitals participating in CMS' program. 

A study published in January 2019 found that during the first two years of the CJR Model, spending per episode decreased slightly without an increase in complications. 

Between 2015 and 2017, spending per episode for joint replacement procedures under mandatory bundles dropped by $812 at hospitals participating in the program. 

Meanwhile, utilization at post acute care facilities fell by nearly 6% during the same period.

Related: Mandatory Bundled Payments Cut Spending $800 Per Joint

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.


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