Earlier this week, on November 16th, the Centers for Medicare and Medicaid Services (CMS) issued the Comprehensive Care for Joint Replacement (CCJR) final rule. This establishes a mandatory demonstration for a hospital-controlled, bundled payment for lower extremity joint replacement patients. The Medicare payment would cover the joint replacement surgery, all hospital related care and all post-acute services included for the 90-day episode after discharge from the hospital. This demonstration serves as yet another effort of CMS and its Center for Medicare and Medicaid Innovation Center to test new value-based payment and delivery models.

When first proposed, the bundle was set to go into effect on January 1, 2016 and be implemented in 75 Metropolitan Statistical Areas (MSAs). Based on significant stakeholder comment, in the final rule, CMS delayed the start date by three months – to April 1 – and removed eight MSAs from the list of participating geographic areas.

The eight geographic areas that were removed from participating are as follows:
1. Colorado Springs, CO
2. Evansville, IN-KY
3. Fort Collins, CO
4. Las Vegas-Henderson-Paradise, NV
5. Medford, OR
6. Richmond, VA
7. Rockford, IL
8. Virginia Beach-Norfolk-Newport News, VA-NC

CMS has announced that they are offering two webinars – November 19 and 30 – to describe the new regulation and answer stakeholder and provider questions stemming from the final rule. Registration is now open for those interested in participating.

Kindred is engaged in a comprehensive review and analysis of the rule.