CMS releases preliminary CJR program results: 7 things to know

CMS recently released preliminary results for the Comprehensive Care for Joint Replacement program, which show hospitals earned $37.6 million in reconciliation payments for the program's initial performance year.

Here are seven things to know about the CJR program and the preliminary results.

1. The CJR model is mandatory for about 800 hospitals across 67 markets, beginning with discharges occurring April 1, 2016, and ending with episodes of care completed by Dec. 31, 2020.

2. The preliminary results show 382 hospitals earned reconciliation payments in the program's first year, which ran from April 1, 2016, through Dec. 31, 2016. CMS noted CJR reconciliation calculations are subject to change since they are conducted 14 months after the close of the performance year.

3. Six hospitals earned payments of $500,000 or more in the first performance year, and one of those hospitals earned more than $1 million, according to CMS. 

4. Under the CJR program, hospitals are placed in one of four quality categories for each performance year: below acceptable, acceptable, good or excellent. Hospitals in the excellent, good or acceptable categories are eligible for reconciliation payments, and those in the excellent or good categories are also eligible for incentive payments.

5. Of the six hospitals that earned more than $500,000, four fell into the excellent quality performance category, while two were in the good quality performance category.

6. The hospital that earned more than $1 million received payment for 850 episodes under the CJR program in the first performance year — the most of any hospital.

7. The lowest reconciliation payment earned in the CJR program's first performance year was $348.66 for three episodes.

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Proposed changes to CJR model will cost Medicare $90M over next 3 years
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