Comparative Joint Replacement Model: What Does It Mean to Me

August 1, 2016
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Rick Gawenda
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The Comprehensive Care for Joint Replacement (CJR) model is a new initiative from the Centers for Medicare & Medicaid Services (CMS) that aims to support improved and more efficient care for Medicare beneficiaries undergoing total knee replacements (TKR) or total hip replacements (THR). CMS implemented the CJR model in 67 geographic areas defined by metropolitan statistical areas (MSAs) on April 1, 2016, for hospitals paid under the Inpatient Prospective Payment System (IPPS) and will continue until December 31, 2020. MSAs are counties associated with a core urban area that has a population of at least 50,000. Non-MSA counties (no urban core area or urban core area of less than 50,000 population) were not eligible for selection.

Participation is mandatory for approximately 800 hospitals in those 67 geographic areas, and hospitals outside of the 67 geographic areas are not able to participate in the CJR model. Hospitals participating in model 1 or Phase II of models 2 or 4 of the Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacements are not eligible to participate in CJR. The CJR model does not apply to Medicare Advantage plans or critical access hospitals (CAHs) since CAHs are not reimbursed under IPPS.

The episode of care for a TKR or THR begins with admission to a participant hospital and is ultimately discharged under MS-DRG (Medicare severity-diagnosis related groups) 469 (major joint replacement or reattachment of lower extremity with major complications or comorbidities) or MS-DRG 470 (major joint replacement or reattachment of lower extremity without major complications or comorbidities) and ends 90 days postdischarge in order to cover the complete period of recovery for beneficiaries. The day of discharge is counted as the first day of the 90-day bundle.

The episode includes all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries, with the exception of certain exclusions. Services included in the CJR model are:

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