CJR spending goals remain unchanged after CMS allows outpatient total knee surgery

CMS may reassess spending benchmarks for total knee arthroscopy under the Comprehensive Care for Joint Replacement model later this year, but plans to leave the targets unchanged for now, according to a 58-page FAQ document published on the model last week.

The agency removed total knee arthroscopy from the inpatient-only list of the Hospital Outpatient Prospective Payment System in 2018, freeing providers to perform this surgery in the outpatient setting. CMS underscored that this move does not mean it expects all total knee arthroscopies to be performed in the outpatient setting.

However, it is likely this move will push healthier patients — who are likely to have shorter, less expensive stays — into the outpatient setting, leaving only the most complex cases as inpatient. This could make it difficult for hospitals to meet current CJR spending benchmarks.

"Currently there are no mechanisms to make adjustments to the CJR target prices should the removal of TKA procedures from the inpatient only list lead to a decrease in the number of actual CJR episodes with shorter, less expensive anchor stays," CMS said in the FAQ. "The CJR model team is actively analyzing claims data and may engage in rulemaking on this issue during 2018."

Read the full FAQ here.


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