CMS last week released the Comprehensive Care for Joint Replacement (CJR) Final Rule, which extends the model for an additional three performance years, through December 2024. CMS previously issued a proposed rule on the CJR Model on February 24, 2020, and subsequently issued two interim final rules with comment periods in response to the COVID-19 public health emergency that also addressed the CJR Model. CMS added outpatient TKA and THA to the CJR model “episode of care” definition with a blended inpatient/outpatient target price to address the recent removal of the TKA and THA procedure codes from the IPO list. CMS also finalized a freeze on the hip fracture list and episode exclusions list, given the relative stability of the ICD-10-CM code set used to determine hip fractures and exclusions and will discontinue the annual sub-regulatory process to update the hip fracture list and episode exclusions list.
CMS has also revised target prices and the high-end salary cap, as well as shifting to one reconciliation period and adding episode-level risk adjustments to adjust the target price at reconciliation using three patient-level risk factors. In response to long standing requests by AAHKS and other stakeholders, CMS eliminated the 50 percent cap on gainsharing payments, distribution payments, and downstream distribution payments when the recipient of these payments is a physician, non-physician practitioner, physician group practice, or non-physician practitioner group practice for episodes that end on or after October 1, 2021, to account for the new end date of PY5. The Final Rule will go into effect on July 2, 2021. Read the summary.