CMS has proposed a mandatory bundled payment model expansion for lower extremity joint replacements under the FY 2027 Hospital Inpatient Prospective Payment System proposed rule.
The proposed Comprehensive Care for Joint Replacement Expanded, or CJR-X, model would apply nationwide to Medicare fee-for-service beneficiaries undergoing hip, knee and ankle replacement procedures in inpatient and outpatient hospital settings, according to the proposal.
Under the model, acute care hospitals would be the formal participants and would be financially accountable for the cost and quality of care across a 90-day episode. The episode would begin with the inpatient admission or outpatient procedure and include related Medicare Parts A and B services, with limited exceptions.
Post-acute care services, including skilled nursing facility care, would be included in the episode. CMS also proposed continuing the 3-day SNF waiver, which would allow eligible patients to be admitted to a SNF without a prior three-day hospital stay.
If finalized as proposed, the first performance year would begin Oct. 1, 2027.
Most IPPS hospitals would be required to participate, with exceptions for hospitals participating in the Transforming Episode Accountability Model, Maryland hospitals, ambulatory surgery centers and hospitals not paid under the IPPS and Outpatient Prospective Payment System.
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