CMS Finalizes Changes to Comparative Joint Replacement Model

The Centers for Medicare and Medicaid Services (CMS) has issued a final rule that makes significant changes to the Comparative Joint Replacement (CJR) model beginning on January 1, 2018. In addition, this rule finalizes the CMS proposal to cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) Incentive Payment Model. The EPMs that have now been canceled include acute myocardial infarction, coronary artery bypass graft and surgical hip/femur fracture treatment episodes of care.

Beginning January 1, 2018, the CJR model will be mandatory in 34 metropolitan statistical areas (MSAs) instead of the current 67 MSAs. For the remaining 33 MSAs, hospitals will be able to choose whether or not they want to participate in CJR in 2018. In addition, CMS is finalizing their proposal that rural hospitals (as defined at § 510.2 as of January 31, 2018) and low volume hospitals, defined as hospitals with fewer than 20 episodes in the historical baseline period used to create the Program Year 1 target prices, in the 34 mandatory participation MSAs are not required to participate in the model, but may opt-in to the CJR model.

CMS is finalizing their proposal to offer a single opt-in period from January 1, 2018 – January 31, 2018 for hospitals not in the mandatory 34 MSAs and for rural hospitals and low volume hospitals in the mandatory 34 MSAs. Hospitals that opt-in during this time period will have an election effective date of February 1, 2018. If hospitals not in the mandatory 34 MSAs and for rural hospitals and low volume hospitals in the mandatory 34 MSAs do not opt-in by January 31, 2018 at 11:59pm EST, their participation in the CJR model will automatically terminate as of February 1, 2018.

To see the CJR mandatory participation MSAs and voluntary MSAs, click