CMS pitches changes to CJR model: 6 things to know

CMS issued a proposed rule Feb. 20, which includes a three-year extension of the Comprehensive Care for Joint Replacement model.

Six things to know:

1. The CJR model, CMS' first mandatory bundled payment initiative, began April 1, 2016, and is slated to end Dec. 31, 2020. Under the payment model, acute care hospitals are held accountable for the quality of care they deliver to Medicare beneficiaries for hip and knee replacement from surgery through recovery.

2. The proposed rule would change the definition of episode of care to include outpatient hip and knee replacements. CMS said it is seeking to modify the definition to address changes to the inpatient-only list that now allows for total knee and hip replacements to be treated in the outpatient setting.

3. The proposed rule includes changes to the target price calculation used for the CJR model. One proposed change is to use the most recent year of claims data to calculate the target price, instead of the three years of claims data that is currently used.

4. CMS is seeking to make several changes to the CJR model reconciliation process, including moving to one reconciliation period, which would be conducted six months after the close of each performance year. Currently, the model uses two reconciliation periods, which take place two and 14 months after the close of each performance year.

5. The proposed rule seeks to extend the CJR model for three years, through Dec. 31, 2023, "to allow time to evaluate the proposed changes," CMS said.

6. CMS will accept comments on the proposed rule until April 20.


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