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cms proposed rule for ccjr

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On July 14, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule in the Federal Register, announcing the implementation of a new Medicare Part A and B payment model called the Comprehensive Care for Joint Replacement (CCJR) model. Under this model, acute care hospitals in 75 selected geographic areas would receive retrospective bundled payments for episodes of care for lower extremity joint replacement or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedures will be included in the episode of care.

CMS anticipates the proposed CCJR model would benefit Medicare beneficiaries by improving the coordination and transition of care, improving the coordination of items and services paid through Medicare fee-for-service, encouraging more provider investment in infrastructure and redesigned care process for higher quality and more efficient service delivery, and incentivizing higher value care across the inpatient and post-acute care spectrum spanning the episode of care. According to CMS, hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods.

CMS proposes to test CCJR for a five year performance period, beginning January 1, 2016, and ending December 31, 2020. Comments will be accepted on the proposals contained in the proposed rule, as well as other alternatives or suggestions, through September 8. Contact Melissa Dehoff at RCPA with questions.