Comprehensive Care for Joint Replacement (CJR) Model Proposed Extension and Changes

Comprehensive Care for Joint Replacement (CJR) Model Proposed Extension and Changes

On February 20, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule in the Federal Register (https://www.federalregister.gov/public-inspection/current) which proposes a three-year extension and changes to the episode definition and pricing in the Comprehensive Care for Joint Replacement (CJR) Model. The CJR Model was established through notice and comment rule making (see https://innovation.cms.gov/initiatives/CJR for links to the relevant rules) and began on April 1, 2016. The Model, which is currently scheduled to end on December 31, 2020, aims to reduce expenditures while preserving or enhancing quality of care by supporting better and more efficient care for beneficiaries undergoing the most common inpatient surgeries for Medicare beneficiaries: hip and knee replacements (also called lower extremity joint replacements or LEJR). This proposed rule proposes to change certain aspects of the CJR Model, including incorporating outpatient hip and knee replacements into the episode of care definition, the target price calculation, the reconciliation process, the beneficiary notice requirements, gainsharing caps, and the appeals process. Additionally, to allow time to evaluate the proposed changes, the rule proposes to extend the length of the CJR Model for an additional three years, through December 31, 2023, for certain participant hospitals.