CMS Proposes Mandatory Hip and Knee Replacement Bundles in 14 New York Counties

The Centers for Medicare & Medicaid Services (CMS) have proposed regulations establishing the Comprehensive Care for Joint Replacement payment model.  This new initiative would require nearly all hospitals in 75 regions nationwide to accept bundled payments for hip and knee replacement surgeries beginning on January 1, 2016.  In New York State, hospitals in Erie, Niagara, Dutchess, Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, and Westchester Counties would be subject to the requirement. 

Under the program, hospitals would be responsible for the quality and costs of care for the entire episode – including almost all Part A and Part B services from the time of the surgery through 90 days after discharge.  Hospitals, physicians, and post-acute care providers would bill Medicare on a fee-for-services basis.  Depending on the quality and total cost during the episode, the hospital would receive an additional payment or be required to repay Medicare for a portion of the episode costs.  To succeed under this payment model, hospitals will have to collaborate with nursing homes, home health agencies, and other post-acute partners.  The demonstration program would run for five years.  This initiative represents a major step in advancing CMS’s goal of making 30 percent of all Medicare payments through an alternative arrangement in 2016 and 50 percent by 2018. 

Comments are due by September 8, 2015 and may be submitted here.

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