A federal proposal to extend the Comprehensive Care for Joint Replacement (CJR) Model by three years will likely have a minimal impact on long-term care providers. The actions of their local hospitals could hold the key, according to a Harvard researcher. 

“The impact may be pretty limited,” Andrew Wilcock, Ph.D., a Siedman Fellow at the Harvard Medical School, told McKnight’s. “The added details on risk adjustment may have more impact on the financial risks hospitals face under the program. It could also reduce pressure to be selective over patients, but this would unlikely change discharge patterns in a major way,” 

“The impact on LTC providers may depend on how their local hospitals and physicians react to including outpatient procedures,” he added. 

The Centers for Medicare & Medicaid Services announced proposed changes to the CJR Model last week. The rule seeks to extend the model, which is currently scheduled to end Dec. 31, by an additional three performance years. It also looks to expand the definition of a CJR “episode” to include outpatient knee and hip replacements.

“We know that roughly 25 [percent] of total knee replacements are being done in the outpatient setting now. According to current rules, CJR does not include them as part of their evaluation. Under the proposed rules, they will be incorporated, which will lower the target prices participating hospitals will face under the program,” Wilcock explained. 

“Hospitals that do more outpatient knees than their regional average will undoubtedly do better in terms of meeting their target price under the new rules. Hospitals that have not shifted more volume to the outpatient setting may be under more pressure to do so under the new rules,” he added. 

Wilcock also noted that the model “only risk adjusted by DRG and fracture in the past,” which raised concerns about safety-net hospitals or other hospitals being unfairly penalized by serving sicker patients. He said the new rules could help alleviate some of the concerns — “if done correctly.”

The model was originally designed to reduce Medicare expenditures while preserving or enhancing quality of care for Medicare beneficiaries, CMS explained. Providers were encouraged to work together to improve care quality through bundled payments and quality measures for episodes associated with hip and knee replacements. 

“Through the innovative design of the CJR program, where hospitals were randomly mandated to participate, we have a good amount of evidence now that the program was able to achieve modest reductions in spending without compromising measurable health outcomes. So, it’s good to see CMS continuing on with a program that has shown some ability to safely save money,” Wilcock said.