Comprehensive Care for Joint Replacement Payment Model Proposed Rule Fact Sheet

CMS released a proposed rule that would implement a new Medicare Part A and B payment model under section 1115A of the Social Security Act (The Act), called the Comprehensive Care for Joint Replacement (CCJR) model, in which acute care hospitals in certain selected geographic areas would receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. The intent of the model is to promote quality and financial accountability for episodes of care surrounding these procedures. Under the proposal, all related care within 90 days after the date of hospital discharge from the joint replacement procedure would be included in the episode of care. CMS believes this five-year model will further its goals in improving the efficiency and quality of care for Medicare beneficiaries for these common medical procedures. CCJR will test whether bundled payments to acute care hospitals for LEJR episodes of care will reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries. During the five performance years, CMS would continue paying hospitals and other providers according to the usual Medicare fee-for-service (FFS) payment systems. However, after the completion of a performance year, the Medicare claims payments for furnished beneficiary services during the episode, based on claims data, would be combined to calculate an actual episode payment.