CMS extends joint replacement model for three years

CMS’ Center for Medicare and Medicaid Innovation on Thursday signed off on a three-year extension of the Comprehensive Care for Joint Replacement model.

It will now last through the end of 2024. The final rule changes the definition of an episode to include outpatient hip and knee replacements, modifies how the agency calculates target prices and reduces the number of reconciliation periods from two to one. It also makes changes to beneficiary notice requirements, gainsharing caps and the appeals process. Regulators expect the extension to save the Medicare program about $217 million over three years.

In addition to extending the CJR model, the final rule makes permanent a three-month extension of the model’s fifth performance year, which will now end March 31. It was initially slated to end at the end of 2020. The rule solidified COVID-19 related flexibilities for the model’s fifth performance year and new diagnostic related groupings for hip and knee procedures.

CMMI originally planned to continue the model through 2023. But it scuttled those plans in light of the COVID-19 pandemic, which wreaked havoc on the healthcare system. Policymakers waived or delayed several reporting and value-based payment requirements in response, but those exceptions will begin to draw to close alongside the public health emergency.

The CJR model is supposed to test if bundled payments and quality measurements for hip and knee replacements cause providers to boost quality and coordinate care from the first hospitalization and throughout the recovery period.