Centers for Medicare & Medicaid Services’ Comprehensive Care for Joint Replacement: The Present and Future for Orthopedic Surgeons

The primary aim of this article is to describe the structure and challenges of Medicare and Medicaid reimbursement for a total hip or knee arthroplasty within the context of the Comprehensive Care for Joint Replacement model. The secondary aims are to identify potential challenges for reimbursement and solutions to overcome challenges for the orthopedic surgeon.

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CMS delays expansion of bundled payment programs

The CMS has delayed the expansion of a major bundled payment pilot, Comprehensive Care for Joint Replacement, and the implementation of its bundled payment initiatives for cardiac care from July 1 to Oct. 1, 2017, according to an interim final rule posted to the Federal Register. It also delayed, for a second time, the effective date of a final rule laying out the implementation of CJR and other bundled payment programs, from March 21 to May 20, 2017.

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CMS Bundled Payment Models Lead to Greater Patient Selectivity

What are some of the biggest problems around bundled payment models and value-based care causing difficulties for physicians? According to Corporate Director at Willis-Knighton Health Systems Chris Mangin, the Comprehensive Care for Joint Replacement Model from the Centers for Medicare & Medicaid Services (CMS) leads providers to refuse joint replacement surgery for patients at higher risk of complications.

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Brown study: No way to predict readmission risk under CJR

CMS launched the Comprehensive Care for Joint Replacement model in April 2016 to compel hospitals to better coordinate care for joint replacement surgery patients in an effort to reduce readmissions and use of expensive post-acute services. The CJR model imposes penalties on hospitals for readmissions of lower extremity joint replacement patients within 90 days of surgery, but a new study from Brown University finds there is no adequate index for predicting readmission risk.

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