ARTICLE SUMMARY:
CMS advances novel payment models in orthopedics. Excerpted from Pathways’ Picks April 15: New Medicare Directions, AI Picks, and Global Regulatory Updates
CMS is relaunching a modified version of its long-running Comprehensive Care for Joint Replacement (CJR) program next year as the first mandatory, nationwide test of an episode-based payment model. From 2016 to 2024, hospitals that participated (some mandatory, some voluntary) in CJR were paid a bundled rate for hip, knee, and ankle replacements, intended to cover the costs of the procedure as well as a 90-day hospital and post-acute period of care. CMS, pointing to data showing the model generated significant Medicare savings while maintaining quality, says it will restart the model October 1, 2027, with required participation for most hospitals. The CJR Expanded Model, including in the IPPS proposed rule, will also incorporate tweaks to the payment methodology that the agency says will do a better job not penalizing hospitals that treat more complex patients. The orthopedic device industry broadly supported and adapted business models to the original CJR, although hospitals and surgeons were wary of the program’s demands.