The Comprehensive Care for Joint Replacement (CJR) Model is a value-based care (VBC) initiative developed by the Centers for Medicare and Medicaid Services (CMS). The model is aimed at incentivizing hospitals to improve the quality and reduce the cost of care for knee, hip, and ankle replacement patients through bundled payments. Launched in 2016 and extended for 3 years in 2021, the model is currently set to run through the end of 2024 and has been implemented at numerous hospitals across the country. However, some hospitals have opted out due to low volumes or substantial concerns surrounding compliance with the increasingly stringent requirements of the CJR model.
This model is in line with ongoing regulatory efforts to standardize care outcomes and lower the cost burden on the US healthcare system by gradually moving from fee-for-service (FFS) models toward VBC as a means of improving care coordination and encouraging providers to consider all aspects of the patient experience throughout the entire 90-day episode of care. Hospitals that achieve high-quality care will effectively be able to keep any savings they incur (and may also receive additional quality-related payments), while hospitals that do not meet the minimum requirements may have to repay costs that exceed the designated spending target.
Participation Changes for Hospitals
Performance year (PY) 7 of the CJR model spans through 2023, while PY 8 (currently the final year) spans through 2024. Having originally required participation from all IPPS hospitals within 67 designated metropolitan statistical areas (MSAs), the model has since been adjusted to require participation from hospitals within 34 of the original 67 MSAs; hospitals in the remaining MSAs were given an option to voluntarily participate in PYs 3-5. With the model being extended in 2021, hospitals in only one of the aforementioned 34 MSAs were required to participate in PYs 6-8; according to the CMS, there are nearly 324 hospitals participating in the CJR model in its final 3 years.
The main reasons for hospitals opting out of the model include low patient volumes, concerns surrounding financial risks, and administrative burdens, particularly as it relates to meeting specific model requirements surrounding collecting, tracking, and reporting extensive patient data.
For example, the University of Florida’s Department of Orthopaedic Surgery was one of the hospitals participating in the mandatory CJR model from 2016 to 2020. During this time, this organization achieved patient volume growth and substantial improvements in length-of-stay, readmission rates, complications, and home discharges, effectively incurring $16.4 million in savings for the CMS. Despite these impressive results, participation ultimately resulted in a net penalty of $304,456 for the organization, illustrating provider concerns surrounding financial risk.
Current and Upcoming Requirements
Generally, the CJR model is focused on three major elements: risk-standardized complication rates (RSCR), hospital consumer assessment of healthcare providers and systems (HCAHPS) survey results, and patient-reported outcomes (PROs) for THA/TKA patients, as well as specific targets for episode-of-care spending.
In PY 7 (2023), providers are required to submit the following PRO data for THA/TKA procedures:
- Post-operative: ≥80% or ≥300 procedures performed between July 1, 2021 and June 30, 2022.
- Pre-operative: ≥85% or ≥400 procedures performed between July 1 2022 and June 30 2023.
In PY 8 (2024), PRO data submission requirements are increased further:
- Post-operative: ≥85% or ≥400 procedures performed between July 1, 2022 and June 30, 2023.
- Pre-operative: ≥90% or ≥500 procedures performed between July 1, 2023 and June 30, 2024.
Notably, these PY 8 requirements had originally been higher, but were revised to lower thresholds due to provider feedback on the ability to meet the minimum data collection requirements. This highlights concerns surrounding compliance even among currently participating hospitals.
To learn more about some of the concerns that have emerged surrounding the Comprehensive Care for Joint Replacement model and how Force Therapeutics can support compliance with CJR requirements, read part II of this blog series or contact us to receive a preview of the impact Force can have on your organization.