CMS' new bundled payment program: 3 things to know
Hip and knee replacement surgeries cost CMS more than $7 billion in 2014, and more than 400,000 beneficiaries went under the knife. Still, there was little consistency in terms of the cost and quality associated with such procedures.
Thus, CMS launched the Comprehensive Care for Joint Replacement Model (CJR) in 2016, a program that is expected to last five years. An April 2016 blog post by Kevin Conway, MD, then-deputy administrator for innovation and quality and chief medical officer at CMS, described the program as a “major step toward transforming care delivery in Medicare.” In his post, Conway highlighted the fact that post-surgical infections or implant failures can be three times higher at some facilities than at others.
Across the country, 791 hospitals in 67 urban areas are taking part in the CJR program, which builds on the agency’s voluntary demonstration projects with bundled payment. These projects include the voluntary Acute Care Episodes (ACE), which ran from 2009 to 2013 and tested the use of global payment for an episode of care, and the Bundled Payments for Care Improvements (BPCI) Initiative, which launched in 2013 and is ongoing; this program is made up of four models of care, which link payments for the various services patients receive throughout an episode of care.
For joint replacement surgeries, CJR begins with a Medicare beneficiary’s admission to a participant hospital and ends 90 days after discharge. Included in those 90 days could be outpatient care, home health, physician services, readmissions, and post-acute facility services. CMS’ goal is to incentivize providers to coordinate care across treatment settings, while reducing unnecessary services and expanding initiatives that hasten patients’ recovery.