10 Things to Know
About Comprehensive Care for Joint Replacement (CJR)
CMS recently finalized a rule to test a new bundled payment model for lower extremity joint replacement beginning April 1, 2016 for 5 year period, concluding on March 31, 2020. Approximately 800 hospitals (Full list available here) within 67 Metropolitan Statistical Areas (MSAs) will be required to participate. Within the model Medicare will begin paying hospitals based on a “target price” for all related joint replacement services within a 90-day episode of care.
- Includes DRGs 469 and 470
- CJR only applies to Medicare beneficiaries
- The program begins April 1, 2016 and continues for 5 years
- Episode “target prices” are set to include all services within a 90-day episode of care.
- Target price set as 98% of historical price – 2% is retained by Medicare.
- Limited loss repayment for missed targets starts 2017. Fully-implemented downside risk begins 2018
- Prices are set based on a blend of previous the 2 years of historical hospital-specific spending and regional spending (i.e. FY12-14 for Year 1).
- Medicare retained portion is reduced from 2% to 1.7% if hospital submits voluntary quality and patient functional outcomes data.
- Three quality measures assessed:
- To receive reconciliation payment, quality performance in years 1-3 must exceed 30th percentile nationally on all measures, years 4-5 exceed 40th percentile nationally