Medicare Payment and Reimbursement

Comprehensive Care for Joint Replacement Payment Model Final Rule Fact Sheet

January 19, 2016 11:54 am

CMS released a final rule that implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act (the Act), called the Comprehensive Care for Joint Replacement (CCJR) model, in which 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. Under the model, all related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. CMS believes that this model will further its goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures. CCJR will test whether bundled payments to acute care hospitals for LEJR episodes of care will reduce Medicare expenditures, while preserving or enhancing the quality of care for Medicare beneficiaries. CMS will continue paying hospitals and other providers and suppliers according to the usual Medicare fee-for-service (FFS) payment systems during all five performance years. However, after the completion of a performance year, CMS will retrospectively calculate a participant hospital’s actual episode spending based on the episode definition.

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