Medicare Mandatory Joint Bundles: April 2016

Comprehensive Care for Joint Replacement (CJR)

CMS has released its final rule for Comprehensive Care for Joint Replacement (CJR) which puts which puts 790 hospitals on notice that hip and knee replacement reimbursements from Medicare will be tied to cost containment and high standards for patient care. CMS will test the initiative at those hospitals from April 1, 2016, through Dec. 31, 2020. Under CJR, participating hospitals will be held accountable for patient care from a hip or knee replacement procedure (the two most common inpatient surgeries for Medicare patients) through 90 days post-discharge. The CJR Model would initially be implemented in 75 geographic areas and, unlike other existing bundled payment programs would be mandatory for hospitals in those areas. Hospitals may be the only risk-bearing entities under CMS’ CCJR proposed model, but there are major implications for post-acute care (PAC) providers.

Based on review of the CJR program, our Access consultant, DataGen, compiled the top seven things PAC providers need to know about and act on to be successful partners in this and other emerging payment models.