Fact Based List:

16 Things to Know About the New CMMI Comprehensive Care for Joint Replacement Model

Submitted by Clive Riddle on Mon, 07/20/2015 - 11:59


  1. The model involves Hip and knee replacements: lower extremity joint replacements or LEJR
  2. In 2013, there were more than 400,000 LEJR inpatient primary procedures in Medicare, costing more than $7 billion for hospitalization alone
  3. The average Medicare expenditure for LEJR surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas
  4. The model tests bundled payment and quality measurement for an episode of care to encourage providers to work together from initial hospitalization through recovery
  5. A LEJR episode is defined as admission of eligible Medicare FFS beneficiary to a hospital paid under IPPS that results in discharge paid under MS-DRG 469 or 470
  6. The LEJR episode would continue for 90 days following discharge
  7. Part A and Part B services related to the LEJR episode would be included in the episode
  8. Annually for 5 years, the model sets Medicare LEJR episode prices for each participant hospital that includes payment for all related services received by eligible Medicare FFS beneficiary
  9. All providers and suppliers would be paid under the usual payment system rules and procedures of the Medicare program for episode services throughout the year
  10. Following the end of a model performance year, actual spending for the episode would be compared to the Medicare episode price for the responsible hospital
  11. Depending each hospital’s performance, the hospital may receive an additional payment from Medicare or be required to repay Medicare for portion of the episode
  12. The CCJR model is proposed for 75 geographic areas, defined by metropolitan statistical areas (MSAs)
  13. Hospitals outside these geographic areas would not be able to participate in the model
  14. Beneficiaries in the 75 MSAs would retain their freedom of choice to choose services and providers
  15. There is no application process for this model
  16. Except for hospitals participating applicable models of the BPCI initiative, hospitals paid under the IPPS and located in selected MSAs be required to participate in the CCJR model


Source: CMMI: Comprehensive Care for Joint Replacement Model
Source URL: http://innovation.cms.gov/initiatives/ccjr/



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