CMS Releases Final Rule on Joint Replacement Save

MedPage Today reports that the Centers for Medicare & Medicaid Services (CMS) has issued a final rule governing payment for hip and knee replacements for Medicare patients this week that includes several concessions to stakeholders, such as delaying implementation from early 2016 to later in the year. Known as the Comprehensive Care for Joint Replacement (CCJR) rule, the new regulation requires bundled payments for joint replacements to the lower extremities over a 90-day "episode of care" in 67 metropolitan areas.

According to CMS, the episode of care begins with an admission to a participant hospital of a beneficiary who is discharged after major joint replacement, with or without major complications or comorbidities, and ends 90 days post-discharge. This will cover the complete period of recovery for beneficiaries, the agency stated, and includes all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries, with the exception of certain exclusions.

Upon releasing the initial rule in July, CMS argued that bundling payments for episodes of care would essentially force different sites and providers to function as a team. 

Changes from the initial to the final rule include:

• Delayed implementation until April 2016
• Reduction in the number of cities -- from 75 to 67 -- that are required to conform to the mandate
• New method for calculating composite quality scores to replace the proposed "threshold methodology"
• Posted notice regarding the waiver of specific fraud and abuse laws, instead of issuing blanket waivers for fraud and abuse
• Elimination of repayment responsibilities in performance year 1 and a more gradual repayment plan thereafter