CMS has released a new final rule that extends the term of the Comprehensive Care for Joint Replacement (CJR) model through December 31, 2024 by adding an additional 3 performance years. The first extended performance year will begin on October 1, 2021. Currently, CJR has been implemented in 67 geographic areas. There are some important changes in the final rule beyond the extension of the payment model.
Let’s start with a quick refresher on CJR. Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries. High rates of complications such as infections and implant failures at certain facilities led to the creation of the payment model. CJR was designed to test a bundled payment with the goal of increasing quality and reducing costs. Providers are given a bundled payment, which includes a bonus or a penalty based on performance for the 90 days after a patient is discharged. The episode of care begins with an admission to a participant hospital of a beneficiary who is ultimately discharged. The episode of care ends 90 days post-discharge in order to cover the complete period of recovery for beneficiaries.
Under the new final rule, CJR has been expanded to include both acute and outpatient surgeries for knees and hips beginning with the first new performance year on October 1, 2021. Also starting October 1st, the target price calculation is based on the most recent year of claims data instead of the previous three years combined. The CJR reconciliation process has also been reduced from two periods to one, which occurs six months after a performance year concludes.