Joint replacement model mandatory areas slashed in CMS proposal

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The CJR model for knee and hip replacements was finalized in November 2015.
The CJR model for knee and hip replacements was finalized in November 2015.

The Centers for Medicare & Medicaid Services wants to drop the number of mandatory geographic areas participating in the Comprehensive Care for Joint Replacement model from 67 to 34, according to a proposal issued Tuesday.

CJR participants in the remaining areas would be allowed to participate in the model on a voluntary basis, as would low-volume and rural hospitals in all of the geographic areas, CMS said.

The proposal would also include cancellation of the Episode Payment and Cardiac Rehabilitation models, in order to offer the agency “greater flexibility to design and test innovations that will improve quality and care coordination across the inpatient and post-acute-care spectrum,” CMS said in its announcement. The proposal to eliminate the models was hinted at in a recent posting on the Office of Management and Budget's website.

“Changing the scope of these models allows CMS to test and evaluate improvements in care processes that will improve quality, reduce costs, and ease burdens on hospitals,” CMS Administrator Seema Verma said in a statement. “Stakeholders have asked for more input on the design of these models. These changes make this possible and give CMS maximum flexibility to test other episode-based models that will bring about innovation and provide better care for Medicare beneficiaries.”

CMS said Tuesday's proposal is the start of what it expects will be an increase in the number of voluntary initiatives, something previously called for by Department of Health and Human Services' Secretary Tom Price, M.D., during his days as a lawmaker.

The proposed rule is slated to be officially published in the Federal Register on Aug. 17, with comments due 60 days later.