By now, everyone in the joint replacement profession has
heard about the Centers for Medicare & Medicaid’s (CMS) final ruling on
bundled payments—the Comprehensive Care for Joint Replacement (CJR) model—that
was released in November 2015. Under CJR, hospitals within 67 geographic
regions must bundle payments for lower extremity joint replacement (LEJR)
Members of the orthopaedic community are understandably
concerned about how the ruling impacts them—particularly with respect to
clinical data registry participation. The American Joint Replacement Registry
(AJRR) has assembled a list of the top 12 things orthopaedic surgeons need to
know about CJR and clinical data registries.
- The CJR
model is about bundled payments. The CJR model aims to support better and
more efficient care for CMS’ beneficiaries undergoing the most common inpatient
surgeries for hip and knee replacements (also called LEJR). This model tests
bundled payments and quality measurement for an episode of care associated with
hip and knee replacements to encourage hospitals, physicians, and post-acute
care providers to work together to improve the quality and coordination of care
from the initial hospitalization through recovery.
program is mandatory for 794 hospitals. The model is required for the 794
hospitals located in 67 Metropolitan Statistical Areas (MSAs) throughout the
country. MSAs are counties associated with a core urban area that has a
population of at least 50,000. The full list of MSAs in this program can be
found at https://innovation.cms.gov/initiatives/cjr
- AJRR can
help. AJRR currently collects LEJR data from at least one hospital in more
than 50 percent of the mandatory areas. We are committed to helping the
remaining hospitals meet the CMS mandate and will provide guidance and support
to utilize our Registry to meet this model.
program begins on April 1, 2016. The first performance period for the CJR
model will begin on April 1, 2016. CMS’ final ruling extended this date from
Jan. 1, 2016. This performance period start date will provide hospitals with
more time to prepare for participation by identifying care design
opportunities, beginning to form financial and clinical partnerships with
providers, and using data to assess financial opportunities under the model.
The first end date for 2016 calendar year will be Dec. 31, 2016. Performance
years 2017, 2018, 2019, and 2020 will include episodes that occur from Jan. 1
through Dec. 31 of each year.
updated the quality-based payment method. Instead of the proposed
performance percentile thresholds for reconciliation payment eligibility, CMS
is finalizing a composite quality score methodology. The composite quality
score is a hospital-level summary quality score reflecting performance and
improvement on the two quality measures finalized for this model (total hip
arthroplasty [THA]/total knee arthroplasty [TKA] complications measure [NQF
#1550] and the Hospital Consumer Assessment of Healthcare Providers and Systems
patient experience survey measure [NQF #0166]) and successful reporting of
THA/TKA patient-reported outcomes (PROs) and limited risk variable data.
outcome measures (PROMs) are currently not a mandatory component of the model.
However, you can earn bonus points for voluntary PRO and risk variable
submission. Hospitals can receive additional “points” toward earning
reconciliation payments through voluntary submission of PRO and risk variable
data. In Year 1, to qualify for bonus “points” for voluntary PRO and risk
variable submission, hospitals must submit data for 50 percent or 50 elective
primary LEJR procedures performed between July 1 and Aug. 31, 2016. For the
first year of the program, PRO data must be collected 90 to 0 days prior to the
LEJR procedure and submitted to CMS by Oct. 30, 2016.
- You will be able to use AJRR’s Level III
platform to facilitate collection of PROs for your patients. AJRR Meets CJR’s
Quality and Outcome Needs.
- Measures for Quality and Outcome Assessment
(AJRR’s Level III data elements)
- Generic Quality of Life PRO measure: VR-12 or
PROMIS 10 Global
- Hip-Specific PRO measure: HOOS, JR (Hip
disability and Osteoarthritis Outcome Score)
- Knee-Specific PRO measure: KOOS, JR (Knee injury
and Osteoarthritis Outcome Score)
- Measures for Risk Adjustment (AJRR’s Level II
- AJRR is adding the following risk variable data
elements, which are required by CJR: patient-reported pain in nonsurgical lower
extremity joint; patient-reported back pain (Oswestry Disability Index);
patient-reported health literacy.
- AJRR can provide you with dashboard and
benchmarks on comparative data from its Registry. You can use these reports to
submit to CMS.
need to submit all of the data on their own behalf. You do not need
attestations or proof from us of your participation.
- The site
where surgery was performed is held accountable. In the CJR model, the
acute care hospital (ie, the site of surgery) will be held accountable for
spending during the episode of care.
- The CJR
is a retrospective bundled payment model. CMS will provide participant
hospitals with Medicare episode prices, called the target prices, prior to the
start of each performance year. Target prices for episodes anchored by Medicare
Severity Diagnosis Related Group (MS-DRG) 469 vs. MS-DRG 470 and for episodes
with hip fractures vs. without hip fractures will be provided to participant
hospitals. The target price will include a discount over expected episode
spending and combine a blend of historical hospital-specific spending and
regional spending for LEJR episodes, with the regional component of the blend
increasing over time. All providers and suppliers furnishing LEJR episodes of
care to beneficiaries throughout the year will be paid under existing Medicare
retain their freedom to choose services and providers. Physicians and
hospitals are expected to continue to meet current standards required by the
Medicare program. The rule also describes additional monitoring of claims data
from participant hospitals to ensure that hospitals continue to provide all
started in the AJRR Registry is easy. For more information about using the
AJRR to meet your mandated CJR requirements, visit www.AJRR.net or phone 847-292-0531 to find the
Program Coordinator in your area.
For a list of CMS frequently asked questions about CJR,
For more information on the AJRR PROMS guide and a list
of the full PRO and Risk Variable Data Elements, visit www.AJRR.net