CJR
Comprehensive Care for Joint Replacement Model
The Comprehensive Care for Joint Replacement (CJR) Model is a retrospective bundled payment model designed to improve care for Medicare patients undergoing hip, knee, and ankle replacements. It incentivizes hospitals, physicians, and post-acute care providers to work together to improve quality and coordinate care from the initial procedure through a 90-day recovery period.
Innovation
The model uses a retrospective bundled payment approach where CMS provides a target price for each CJR MS-DRG prior to the performance year, holding hospitals financially accountable for the quality and cost of a 90-day episode of care.
The Problem
Hip, knee, and ankle replacements are the most common surgeries Medicare beneficiaries receive. Many patients experience confusing, uncoordinated care before and after their surgery, which can lead to complications or prolonged recovery.
The Solution
Participating hospitals take on additional responsibilities to ensure patients receive high-quality, coordinated care by all health care providers from the time of the procedure through recovery, including physical therapy and at-home rehabilitation.
Expected Outcomes
Patients have a safe, effective, and positive recovery experience that is free from complications, while maintaining their freedom of choice in providers and services.
Model Goals
- Improve the quality and coordination of care from the initial hospitalization or outpatient procedure through recovery
- Ensure a safe, effective, and positive recovery experience free from complications
- Avoid expensive and harmful events which increase episode spending
Patient Eligibility
Eligible Medicare fee-for-service beneficiaries receiving a lower extremity joint replacement at a participant hospital.
- Medicare fee-for-service beneficiary
- Admitted to a hospital paid under the Inpatient Prospective Payment System (IPPS)
- Discharged under MS-DRG 469, 470, 521, or 522
- Includes outpatient procedures for TKAs and THAs
Provider Eligibility
Hospitals paid under the Inpatient Prospective Payment System (IPPS) located in selected Metropolitan Statistical Areas (MSAs).
- Hospital paid under the Inpatient Prospective Payment System (IPPS)
- Located in one of the 34 required MSAs (for PYs 6-8)
- Not designated as a low volume or rural hospital
Care Categories
Orthopedic Surgery
CMS Benchmarks & Thresholds
eligibility
financial
operational
population
quality
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