CMS Finalizes Regulations Governing Bundled Payments for Joint Replacements

On Mon., Nov. 16th, CMS announced that it had finalized regulations governing the Comprehensive Care for Joint Replacement (CJR) model.  Under the final regulations, all hospitals in 67 metropolitan statistical areas will be paid for lower extremity joint replacements, performed on Medicare fee-for-service beneficiaries, based on costs and quality within a 90-day episode of care.   The model provides financial incentives for hospitals to partner with physicians and post-acute care providers, such as home health agencies and nursing homes, to coordinate care and optimize outcomes, while reducing overall costs.  The following counties in New York State were selected for the new model: Dutchess, Bronx, Kings  Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Westchester, Erie, and Niagara.

The CJR model will take effect on Apr. 1, 2016. The final regulations will be published on Nov. 24th.  An unpublished version of the regulations is available here.  More information is available here. LeadingAge New York will be providing additional information about the model both through Intelligence and via a free webinar for members. 

Contact:  Karen Lipson, klipson@leadingageny.org, (518)867-8383 ext. 124