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CHA has released the attached summary, prepared by Health Policy Alternatives, Inc., detailing the Centers for Medicare & Medicaid Services (CMS) proposed rule implementing the Comprehensive Care for Joint Replacement (CCJR) model, a new Medicare Part A and B payment model. The proposed rule would require acute care hospitals in certain selected geographic areas, including three in California, to participate in the CCJR model and receive bundled payments for episodes of care where the diagnoses at discharge included lower extremity joint replacement or attachment of a lower extremity that was furnished by the hospital. The summary details provisions of the proposed rule, including the definition of the episode initiator; methodology for setting episode prices and payment for model participants; and the use of quality measures and data sharing.
The summary also describes the methodology that CMS used to determine which metropolitan statistical areas (MSAs) would be selected for mandatory participation in the model. CMS has proposed participation for three California MSAs, including Los Angeles-Long Beach-Anaheim (Orange County and Los Angeles County), Modesto (Stanislaus County), and San Francisco-Oakland-Hayward (Alameda County, Contra Costa County, San Francisco County, San Mateo County and Marin County). This presents a significant shift in Medicare payment for hospitals that have high volumes of joint replacements (DRGs 469 and 470).
CHA is currently preparing a CHA DataSuite analysis to inform its analysis and comments. CHA will host a member call Aug. 14 from 11 a.m. – noon (PT) to provide an overview of the proposed rule and seek member input for CHA’s comments. CHA is particularly interested in hearing from members in the affected MSAs. A list of impacted hospitals is attached. To register for the call, visit www.surveymonkey.com/r/ccjrproposed. Comments on the proposed rule are due Sept. 8.
