July 10, 2015
CMS Proposes Retrospective Bundled Payment for Hip and Knee Arthroplasty
On July 9, 2015, the Centers for Medicare and Medicaid Services (CMS) released a rule proposing a new payment model for hip and knee replacement. CMS will accept comments on this proposal until Sept 8, 2015. If the proposal is finalized, the program would begin on Jan 1, 2016 and run for five years.
Under this proposed Comprehensive Care for Joint Replacement (CCJR) model, hospitals will be held accountable for the quality and cost of these lower extremity joint replacement episodes with the episode starting at admission and ending at 90 days post-discharge. The rule would require that hospitals located in 75 specified metropolitan statistical areas (MSA) participate in the program.
In describing this model, CMS states, “All providers and suppliers would be paid in accordance with usual rules and procedures of the payment systems for the year. Following the end of a model performance year, actual episode spending for the episode (total expenditures for related services under Medicare Parts A and B) would be compared to the Medicare episode price for the responsible hospital. Depending on the participant hospital’s quality and episode spending performance, the hospital may receive an additional payment from Medicare or may need to repay Medicare for a portion of the episode spending.”
More information is available from the CMS website at http://innovation.cms.gov/initiatives/ccjr/