CMS finalizes bundled payment initiative for hip, knee replacements: 7 key notes

Orthopedic Sports Medicine

CMS has finalized a new bundled payment model for hip and knee replacement surgery in acute-care hospitals.

Here are seven key notes:


1. Under the Comprehensive Care for Joint Replacement model, acute-care hospitals in certain selected geographic locations will receive retrospective bundled payments for episodes of care for lower extremity joint replacement or reattachment of a lower extremity.


2. All related care, within 90 days of hospital discharge from the procedure, will be included in the episode of care.


3. The regulations are effective on Jan. 15, 2016 and applicable on April 1, 2016.


4.  To allow hospitals time to gain experience under the new model, CMS is finalizing a payment policy for participating hospitals that includes:


•    No repayment responsibility in performance year one
•    A stop-loss limit of 5 percent in performance year two
•    A stop-loss limit of 10 percent in performance year three
•    A stop-loss limit of 20 percent in performance years four and five


5. The CJR Model will be implemented in 67 metropolitan statistical areas.


6. Hip and knee replacements prove costly for CMS. More than 400,000 Medicare beneficiaries received a joint replacement in 2014, costing CMS more than $7 billion.


7. The CJR model's goal is to give hospitals a financial incentive to work with physicians, home health agencies, skilled nursing facilities and other providers, promoting coordinated care.


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