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CMS Issues Comprehensive Care for Joint Replacement Final Rule 

For CEOs, CFOs, COOs, CMOs, CNOs

On April 29, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that makes changes to the Comprehensive Care for Joint Replacement (CJR) payment model for hip and knee replacements. 

The rule extends the CJR model for three additional performance years — Oct. 1, 2021, through Dec. 31, 2024 — for hospitals in the 34 mandatory CJR markets, including those in the Los Angeles, Long Beach, and Anaheim metropolitan statistical area (MSA). Hospitals that elected to participate in the 33 voluntary CJR MSAs or that are in one of the mandatory CJR MSAs and meet the low-volume or rural criteria are excluded from participating in the three-year extension of the program.  

The rule changes the definition of a CJR episode to include lower extremity joint replacement procedures performed in hospital outpatient departments. It also makes several technical changes to the target pricing methodology. This includes reducing the number of years of claims data used as the basis for episode target prices from three years to the most recent year of claims data to accommodate the inclusion of joint replacements performed in the hospital outpatient department. 

CMS also finalized changes to the episode reconciliation process such as reducing the number of reconciliation periods from two to one conducted six months after the end of the performance year, adding an additional episode risk adjustment factor, and adding a retrospective trend adjustment factor.  

CMS estimates the changes in the final rule will save the program $217 million over the additional three model years. Additional details are available in a CMS fact sheet. CHA will provide a summary of the CJR final rule soon.