Potential Impact of Medicare Comprehensive Care for Joint Replacement Model

The Centers for Medicare & Medicaid Services (CMS) in July issued a bundled payment model for major joint replacement of the lower extremity called the Comprehensive Care for Joint Replacement (CCJR) model.  This model is to be implemented in 75 regions across the country – it will be mandatory for most hospitals in those areas. An episode would be defined as 90 days after hospital discharge. Virginia has three Metropolitan Statistical Areas (MSA) – Richmond, Staunton, and Hampton Roads – which have been selected for inclusion, meaning as many as 23 hospitals could be affected. So what is the likely impact for hospitals required to participate in the CCJR model? Preliminary data suggests nine hospitals could be financial losers, 12 could be winners, and two would break even.  The chart below illustrates average episode payment costs for all Virginia hospitals which perform joint replacements, CCRJ-included Virginia hospitals, and joint replacement data for applicable hospitals nationwide. It also includes the estimated regional average payment episode against which participating hospitals will be measured. Comments on the proposed rule are due to CMS Sept. 8. (9/4/2015)