CJR Final Rule Released

3/1/2016

Comprehensive Care for Joint Replacement Model (CJR)

The Comprehensive Care for Joint Replacement Model (CJR) will test a new payment model for episodes of care initiated by hospital stays for lower extremity joint replacements. Under the CJR model, hospitals will be at financial risk for the care provided during the initial hospital stay plus 90 days after discharge from the hospital. The model will be tested for a 5-year time period beginning April 1, 2016. APTA is working to support members in their success within this model by providing resources.

For more information, go to: http://www.apta.org/BundledModels/CJR/

Questions regarding CJR should be sent to advocacy@apta.org.

The Comprehensive Care for Joint Replacement (CJR) rule was released.

Highlights:

The model focused on elective primary hip and knee replacement patients and would include the inpatient stay and all related care within 90 days of hospital discharge from the joint replacement procedures.

MS-DRG 469: Major joint replacement or reattachment of lower extremity with major complications or comorbidities
MS-DRG 470: Major joint replacement or reattachment of lower extremity without major complications or comorbidities
The CJR model will begin April 1, 2016 and will last for 5 years.
Under the model, all inpatient prospective payment hospitals in the 67 selected metropolitan areas must participate in this model.
Participant hospitals financially accountable for the quality and cost of a model episode of care and incentivize increased coordination of care among hospitals, physicians, and post-acute care providers.
Participant hospitals may have certain financial relationships with collaborators to support their efforts to improve quality and reduce costs. These collaborators can share in the reconciliation payments and internal cost savings realized through care redesign activities. Collaborators may include the following provider and supplier types:
- Physicians and nonphysician practitioners
- Home Health Agencies
- Skilled Nursing Facilities
- Long Term Care Hospitals
- Physician Group Practices
- Inpatient Rehabilitation Facilities
- Providers or suppliers of therapy services

There will be 2 mandated quality measures for the model and optional patient reported quality measures in year one:

Hospital-level RSCR following elective primary THA and/or TKA (NQF #1550), an administrative claims-based measure
HCAHPS Survey measure
PROMIS Global or VR (Veterans RAND) 12 (optional)
HOOS Jr or HOOS Pain AND Function, Daily Living Subscales/ KOOS Jr or Stiffness, Pain AND Function, Daily Living Subscales (optional)

CMS will waive certain rules in order to test the CJR model, specifically:

Waiver of the 3 day inpatient hospital stay requirement for eligibility for a covered SNF stay (ie. SNF 3 day rule) if the SNF is rated 3 stars or higher on Nursing Home Compare. This waiver will not apply during performance year 1 but will in years 2-5.
Waiver of the “incident to” rule for physician services to allow clinical staff of a physician to furnish home visits. (only for non HHA covered patients).
Waiver of current law limitations on payment for telehealth services that will allow telehealth services to be furnished in the beneficiary’s home or place of residence. These waivers will not permit coverage and payment for telehealth services, such as physical therapy, that are not currently covered.
CMS website: https://innovation.cms.gov/initiatives/cjr
APTA is working to create a variety of new resources in early 2016, please see our webpage: http://www.apta.org/BundledModels/CCJR/