Hip and knee bundles may receive 3-year extension

The Comprehensive Care for Joint Replacement Model, which covers hip and knee joint replacement bundled payments, could see a three-year extension, CMS announced in a proposed rule.

The CJR model began in 2016 and is scheduled to end on Dec. 31, 2020. It aims to cut Medicare expenditures by bundling all care for hip and knee joint replacements into one episode of care while increasing overall quality. The new proposal would keep the bundled payment model through Dec. 31, 2023.

However, the proposal does include other changes to the model and would include outpatient hip and knee replacements into the episode of care definition. The proposal also changes the target price calculation, the reconciliation process, the beneficiary notice requirements, gainsharing caps and the appeals process.

Including outpatient joint replacements changes the definition from the current model that only includes inpatient-only procedures. The bundled payment allows hospitals to cover an entire 90-day episode of care. One 2019 study found the CJR model saved about $1,000 per patient annually, while another study from the New England Journal of Medicine found a 3.1% savings rate, or about $812 per patient.

CMS also proposed changing the target price from three years of claims data to just the most recent one year of data, as well as removing other updates and incorporating risk adjustment into the target price. It also proposed to change the high episode spending cap calculation methodology.

The proposal also makes changes to the reconciliation process, bringing it down from two periods to one period. Currently, hospitals can reconcile payments two months and 14 months after the close of each performance year. Under the proposal, hospitals could conduct a reconciliation period six months after the close of each performance year.

See the proposed rule on the Federal Register here.