Near the end of 2015, the Centers for Medicare and Medicaid (CMS) published its final rule for Comprehensive Care for Joint Replacement (CJR), a bundled-payment model for hip and knee surgeries. CMS has signaled that there will be more of these programs as the industry shifts from fee-for-service to value-based care. Unlike other bundled-payment models, this program is not optional. In 2014, more than 400,000 Medicare beneficiaries received a hip or knee replacement. Post-acute care, such as skilled nursing or physical therapy, follows many of the hospital stays for these patients. Homecare can be an important contributor to ensure the patient is not re-hospitalized during this period. CJR goes into effect January 15, 2016 and is applicable on April 1, 2016, when the first model performance period begins. There has been a lot of discussion about what the CJR rule […]

On November 16, the Centers for Medicare & Medicaid (CMS) published the Comprehensive Care for Joint Replacement (CJR)* final rule, marking a significant milestone in the advancement toward value-based care. “Today, we are embarking on one of the most important steps we will take to improve the quality and value of care for hundreds of thousands of Americans who have hip and knee replacements through Medicare every year,” said Sylvia Burwell, secretary of Health and Human Services. CJR will test whether or not bundled payments to hospitals for lower extremity joint replacement (LEJR) surgery episodes will reduce Medicare expenditures and enhance the quality of care for beneficiaries.  Due to the high number of public comments, the rule has expanded from about 400 pages to more than 1000. What changed from the proposed rule to the final rule Our preliminary observations […]