On April 1, 2016, select hospitals will be required to begin participation in the Centers for Medicare & Medicaid Services (CMS)
Comprehensive Care for Joint Replacement model (the “CJR Model”). Hospitals will be required to comply with the finalized regulations that
were released by CMS on November 12, 2015. Participating hospitals will receive bundled payments for lower extremity joint replacement
(LEJR) procedures and related care. The CJR Model will also involve potential incentive payments a hospital can receive for meeting certain
objectives, including reducing costs below a set target amount for the episode of care, and potential payments a hospital could be required
to make to CMS in the event set target amounts are exceeded.
The CJR Model will be tested over five performance years, beginning April 1, 2016, and ending December 31, 2020. The objectives of the
model are to increase the quality and efficiency of care for patients undergoing LEJR procedures and to encourage alternative protocols in
order to reduce overall costs with respect to these procedures, as these procedures have been found to require lengthy and costly recovery
and rehabilitation periods and have a high rate of complications. CMS has indicated that hip and knee replacement surgeries are the most
common inpatient surgery for Medicare beneficiaries, and thus, a key area where alternative treatment plans can have a considerable impact.
white paper outlines the key requirements of the CJR Model and how to partner with collaborating providers in a easy to read Q&A format.