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

CMS released a proposed rule in August to scale back the Comprehensive Care for Joint Replacement model, a move that is estimated to cost Medicare $90 million over the next three years. 

In November 2015, CMS finalized the CJR model, which holds acute care hospitals accountable for the quality of care they deliver to Medicare beneficiaries for hip and knee replacement from surgery through 90 days after discharge. The five-year program is mandatory for about 800 hospitals across 67 markets, beginning with discharges occurring April 1, 2016, and ending with episodes completed by Dec. 31, 2020. Over the remaining three years of the program, the CJR model is estimated to save the Medicare program $294 million. 

CMS proposed in August to trim back the CJR model. Under the proposed rule, the program would be mandatory for hospitals in 34 of the 67 geographic areas chosen for the program. The CJR model would continue on a voluntary basis in the other 33 geographic areas. The proposed rule would also make participating in the CJR model voluntary for all low volume and rural hospitals in the 67 areas.

CMS estimates those changes, if finalized, would reduce projected savings from the CJR model by $90 million over the remaining three-year performance period. Therefore, the CJR model would save the Medicare program $204 million instead of $294 million.

CMS will accept comments on the proposed rule until Oct. 16.

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