Top 10 Things to Know about The Comprehensive Care for Joint Replacement (CJR) Program

  • The Comprehensive Care for Joint Replacement (CJR) program is an outcomes-based payment model that holds participating hospitals accountable for hip or knee replacement surgery (MS-DRG 469/470) patients
  • Close to half a million people could fall into the program every year
  • 67 geographic areas including 791 hospitals are impacted
  • Post-acute care is taking a major role in the program as participating hospitals are responsible for the episode of care through 90 days post-discharge
  • Every year, the Centers for Medicare & Medicaid Services (CMS) will provide participating hospitals updated target prices for the covered episodes
  • Hospitals will be reimbursed through a fee-for-service model throughout the year
  • At the end of the year, payments will be reconciled to the established CJR target prices. If the total payments made are less than the established price, a hospital will receive a payment; if the total payments made are more than the established price, a hospital will have to repay some or all of the difference
  • Quality measures under the CJR include: a compliance measure, a patient satisfaction measure, and a self-reported patient-reported outcome measure
  • Quality score will impact a hospital's CHR payment in two ways: if a hospital receives a poor quality score, they will be ineligible to receive reconciliation payments regardless of performance on cost; the composite quality score will determine the "effective discount percent" for reconciliation and repayments
  • Hospitals are allowed to enter into risk-sharing agreements with other providers such as:
    • Physicians or non-physician practitioners
    • Physician group practices
    • Inpatient rehab facilities
    • Long-term care hospitals
    • Skilled nursing facilities
    • Home health agencies
    • Provider/supplier of outpatient therapy services

For more information on the CJR program, please visit the CMS CJR information page at https://innovation.cms.gov/initiatives/cjr.

- By Jvion Health