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CMS Announces Comprehensive Care for Joint Replacement (CJR) Model Reforms

Feb 28, 2020

The Centers for Medicare and Medicaid Services (CMS) recently announced a series of proposed reforms for the Comprehensive Care for Joint Replacement (CJR) model.

One of the proposed reforms would be to extend the length of the CJR model for an additional three years (through December 31, 2023) for certain participant hospitals. 

Another proposed reform would be to revise components of the CJR model, including editing the criteria for defining an “episode of care” to include outpatient procedures, proposing changes to the target price calculation in order to improve the accuracy of CJR episode pricing and to cut costs for the Medicare program, modifying the beneficiary notification requirements, and modifying the appeals process for this specific model. 

Another proposed reform would be to modify payment schemes within the additional three years proposed by eliminating the 50% cap on gainsharing payments, distribution payments, and downstream distribution payments for certain recipients. 

A final proposed reform would be to solicit comments for a potential design of a bundled payment model for lower extremity joint replacement (LEJR) procedures performed in the ambulatory surgical center (ASC) setting. 

For a detailed overview of the proposed reforms to the CJR model, visit the Federal Register and research proposed rules on February 20, 2020. The proposed rules of interest fall under Centers for Medicare & Medicaid Services.