CMS scales back bundled payment programs

On November 30, 2017 CMS cancelled both the mandatory hip/femur fracture (aka SHFFT) and cardiac bundled payment models which were pending for 2018. In addition, CMS scaled back the Comprehensive Care for Joint Replacement (CJR) model, also known as the mandatory bundled payment model for total knee/total hip replacements (TKA/THA) which was effective in April of 2016.

CMS reduced the number of mandatory geographic areas participating in CJR from 67 areas to 34 areas. CMS is also making participation voluntary for all low volume and rural hospitals participating in the model in all 67 geographic areas. The fifth and final performance year will end on December 31, 2020.

A list of all CJR participant hospitals, their MSAs, the status (mandatory or voluntary) of their MSAs, and their status as rural or low volume, if applicable, has been posted on the CJR webpage at: (Scroll way down and you’ll see a hospital list PDF you can download.)

“While CMS continues to believe that bundled payment models offer opportunities to improve quality and care coordination while lowering spending, we believe that focusing on developing different bundled payment models and engaging more providers is the best way to drive health system change while minimizing burden and maintaining access to care. We anticipate announcing new voluntary payment bundles soon,” said CMS Administrator Seema Verma. CMS feels certain that “altering the scope of the CJR model offers CMS flexibility to design and test other episode-based payment models while evaluating the ongoing CJR model.”

Private practitioners with current contractual relationships should check to verify that the hospital with which they are contracted is still required to, or has the option to and still plans to, participate in the CJR model. In cases where a therapist is not currently participating in the model, but their practice is located near or interacts with a participating hospital, the therapist should decide if participation in the CJR model is beneficial, essential, or desirable to their practice. PTPN has tools on our website to help you with the CJR model.

Learn more at the Political Action Center.