CMS proposes changes to total joint bundled payment program

Editor's Note

The Centers for Medicare & Medicaid Services (CMS) on February 20 issued a rule proposing changes to the Comprehensive Care for Joint Replacement (CJR) program, which bundles payments to acute care hospitals for hip and knee replacement surgical procedures.

CMS proposes extending the CJR model for an additional 3 years, through December 31, 2023, for hospitals in the 34 metropolitan statistical areas where participation was mandatory. Hospitals in the 33 voluntary metropolitan areas and low-volume and rural hospitals that have volunteered to participate will see the model end December 31, 2020.

The proposed changes also include incorporating outpatient hip and knee replacements into the episode of care definition, target price calculation, reconciliation process, beneficiary notice requirements, gainsharing caps, and appeals process.