Joint replacement model mandatory areas slashed in CMS proposal

The proposal reduces the number of mandatory geographic areas for the joint bundled payment program and cancels the cardiac bundled payment program model.

In a rule (PDF) posted yesterday in the Federal Register, CMS proposed reducing the number of regions participating in the mandatory Comprehensive Care for Joint Replacement program from 67 to 34, while allowing the remaining 33 regions to participate voluntarily.

CMS officials sent the rule proposed on August 14 to the Office of Management and Budget last week, canceling the mandatory bundled payment program for heart attacks and bypass surgery as well as proposed expansion of CJR to cover hip and femur fractures that would have taken effect January 1.

The CJR model for knee and hip replacements was finalized in November 2015.

The Centers for Medicare and Medicaid Services on Tuesday officially announced it is pulling back from mandatory bundled payment models set up under the Obama administration. "Eliminating these models would give CMS greater flexibility to design and test innovations that will improve quality and care coordination across the in-patient and post-acute care spectrum", CMS said in its announcement. "We look forward to continuing to work together with CMS to find effective ways to improve quality of care and reduce costs through innovative payment models", he said.

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To attempt to rectify these cost and quality issues, CMS under the Obama administration originated the CJR model, which holds participant hospitals financially accountable for the quality and cost of a CJR episode of care and gives hospitals, physicians, and post-acute care providers incentives to coordinate care. "The changes in the proposed rule would allow the agency to engage providers in future voluntary efforts, including additional voluntary episode-based payment models". Others have opposed the speed at which the mandatory bundles were being implemented, despite delays in implementation in some instances.

"We believe CMS is taking a very sensible and reasonable step in evaluating innovations on a voluntary rather than mandatory basis", Bill Dombi, interim president for the National Association for Home Care & Hospice (NAHC), told Home Health Care News on Tuesday.

Public comment is due by October 16.

Read the full proposed rule here.

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