Pandemic delays proposed changes to CMS joint replacement model — 6 things to know


The COVID-19 pandemic is delaying proposed changes to CMS' Comprehensive Care for Joint Replacement Model, Medscape Medical News reports.

What you should know:

1. CMS' current CJR Model has been in place since April 1, 2016, and it's designed to test bundled payment and quality measurement for joint replacement episodes of care. A 2019 study found the model to be effective in its first two years; the cost of joint replacements modestly decreased with no change in complication rates, according to researchers at the Harvard T.H. Chan School of Public Health in Boston.

2. With the rules set to expire at the end of 2020, CMS in February proposed extending the model for three years and put forth several possible changes:

  • "Episode of care" would be redefined to include outpatient total knee and total hip arthroplasty.
  • Target price calculations would be based on one year of claims data rather than three years of data.
  • There would be one reconciliation period rather than two, and it would be conducted six months after the conclusion of a performance year.

3. CMS planned to accept comments on its proposed revisions until April 24, but given how the coronavirus pandemic is unfolding, the agency decided in April to extend the comment period to June 23 of this year.

4. CMS will also extend the original CJR Model by three months. The rules for joint replacement surgery, which are mandatory for involuntary participants, are now set to expire March 31, 2021.

5. The American Academy of Orthopaedic Surgeons "strongly" opposes the model's mandatory nature and takes issue with excluding voluntary participants in the proposed three-year extension, according to Wilford Gibson, MD, chair of the AAOS Council on Advocacy.

"In general, though, I think the rule changes that CMS is proposing all sound like very reasonable tweaks to a policy," Dr. Gibson told Medscape. "They are just adapting to the healthcare landscape as it has changed over the last few years."

6. The pandemic has led orthopedic groups around the country to cancel or postpone elective surgeries, meaning 2020 data "will almost certainly be skewed," Medscape reports. As a result, AAOS is advocating for the original CJR Model to be extended to the end of 2021.

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