Comprehensive Care for Joint Replacement Model

The Comprehensive Care for Joint Replacement (CJR) Model is a new rule proposed by the Centers for Medicare & Medicaid Services for hip and knee replacements, or lower-extremity procedures. CJR is a five-year program that began on April 1, 2016, and will be mandatory in 67 selected geographies. Medicare selected Lower Extremity Joint Replacement due to the high volume and variable spending across multiple regions.

Required Participation

Participation in CJR is mandatory for hospitals in those selected areas and will incorporate Bundled Payments, which allows hospitals to share risk and reward with physicians and post-acute providers. The bundles are retrospective, similar to the Bundled Payments for Care Improvement Initiative (BPCI) Model 2,and total Medicare expenditures are calculated and then compared against a pre-assigned target price.

Hospitals must assume full responsibility for the risk commencing in year two, and will be held financially accountable if they do not meet certain financial and quality targets set by CMS.

CJR Quality Measures

  • Hospital-level 30-day, all-cause Risk Standardized Readmission Rate (RSRR) following the procedures
  • Hospital-level Risk Standardized Complication Rate (RSCR) following the procedures
  • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey measure

What the Bundles Include

The bundles include the in-patient stay and 90 days, post discharge.

Who Will Be Affected?

The care of Medicare beneficiaries meeting certain criteria who have an inpatient hospitalization for lower extremity joint replacement (LEJR) as designated by MS-DRG 469 or 470 at participant hospitals would be included in the model. These MS-DRGs primarily include single-joint total hip and total knee replacement procedures. The participant hospitals are those hospitals paid under the Inpatient Prospective Payment System (IPPS) in selected MSAs and not currently participating in Model 1 or Phase II of Models 2 or 4 of the Bundled Payments for Care Improvement initiative for the lower extremity joint replacement clinical episode. Proposed MSAs were selected using a stratified randomized method. Please click on the link below to see if your hospital is in one of the selected MSAs.

http://innovation.cms.gov/initiatives/cjr/

If your hospital is not prepared for the changes due to bundled payments, please give us a call. We are experts with more than 30 years of experience in Bundled Payments. 866-458-6076.

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