CMS Issues Final Rule in Comprehensive Care for Joint Replacement Payment

The Centers for Medicare and Medicaid Services (CMS) has issued a final rule to implement a Comprehensive Care for Joint Replacement model of payment.  Under this model,  acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. The bundle will include the inpatient stay and all associated care within 90 days post discharge. Hospitals and providers will be paid per usual Fee for Service mechanisms and after completion of the episode, total payments will be compared to a target.  The hospital may receive additional payment if specific quality metrics are met and the costs of care are below the target.  The hospital may be required to issue repayment if costs exceed the target.

At the urging of ASA and other stakeholders the implementation date of the program was delayed slightly until April 1, 2016.  ASA is working in conjunction with other specialties to determine next steps to address the start date and other concerns in the rule.  The model will run from April 1, 2016 through December 31, 2020.

ASA is currently reviewing the rule and will post more information in upcoming postings.

Read the final rule.

Read ASA's comments on the proposed rule.