More than 350 of the roughly 800 hospitals in CMS' Comprehensive Joint Replacement (CJR) model will receive reconciliation payments for the program's first performance year, according to preliminary CMS data.
The CJR model holds participating hospitals accountable for episodic spending performance on eligible fee-for-service hip and knee replacements for Medicare beneficiaries. Hospitals that meet certain benchmarks for quality and cost measures will receive a bonus payment, while hospitals that exceed the set target could be penalized.
Based on those benchmarks, hospitals are grouped into one of four quality categories:
- Acceptable; or
- Below acceptable.
Hospitals' that receive an acceptable, good, or excellent score qualify for a reconciliation payment, and those that receive good and excellent score may also qualify for incentive payments, according to Becker's Hospital Review. The model's first performance year ran from April 1, 2016 to Dec. 31, 2016.
CMS has implemented the model in 67 U.S. regions, and CJR is currently mandatory for the approximately 800 hospitals in those areas.
Preliminary CJR results
CMS' preliminary results show that 382 out of the roughly 800 hospitals participating in the CJR program received reconciliation payments.
Based on the preliminary data, CMS estimated it will be awarding a total of $37.6 million in reconciliation payments, ranging from $348.66 for one hospital that had three care episodes to more than $1.2 million for one hospital that had 850 care episodes. Six hospitals earned at least $500,000. The hospitals that are not expected to receive reconciliation payments, RevCycleIntelligence reports, exceeded their target cost thresholds but will not face any financial penalties in the first performance year.
Of the 382 hospitals receiving payments, the preliminary data show:
- 150 earned an excellent quality score;
- 201 earned good score; and
- 31 earned an acceptable quality score.
CMS noted that the reconciliation payment amounts "are subject to change as the final reconciliation calculations for each performance year occur 14 months after the close of the performance year to allow for updated data, claims run out, adjustments for model overlaps, and other adjustments" (Belliveau, RevCycleIntelligence, 10/18; Ellison, Becker's Hospital CFO Report, 10/18; CMS website, accessed 10/20).
Upgrade your joint replacement pathway for CJR
The Comprehensive Care for Joint Replacement (CJR) model is CMS’s first mandatory bundled payment program. It holds hospitals accountable for managing outcomes across a 90-day episode of care for two common Medicare inpatient surgeries—hip and knee replacements.
Consider these five strategies to reduce variation across the joint replacement care episode, and then access our Joint Replacement Pathway Toolkit to find implementation guidance and resources.