STATEMENT: CAP’s Maura Calsyn on Joint Replacement Rulemaking by CMS

Washington, D.C. — Yesterday, the Centers for Medicare & Medicaid Services, or CMS, finalized the Comprehensive Care for Joint Replacement, or CCJR, model. The final rule tests the use of bundled payments for knee and hip replacement procedures. Maura Calsyn, Director of Health Policy at the Center for American Progress, released the following statement in response to the news:

CAP applauds the administration’s decision to finalize the CCJR model. In doing so, Medicare has sent the strongest signal yet to the entire health care system about its commitment to move away from the fee-for-service payment system. Bundled payments are a critical payment and delivery system reform, and this is the first time a CMS Innovation Center payment model has applied to all medical providers in a particular area geographic area. We hope that Medicare’s action will catalyze other payers to adopt similar bundled payments.

The final rule includes modest changes from the proposed rule, but the two most critical parts of the model are still in place. First, payment under the model is based not just on the actual knee or hip replacement surgery but also on related care for 90 days postdischarge. This payment approach should transform care, encouraging hospitals and physicians to work together to coordinate care on a case-by-case basis.

Second, the model remains mandatory for hospitals in almost 70 areas, which will allow CMS to evaluate the payment model across a wide variety of providers. Guaranteed large-scale participation will give CMS the robust data necessary to inform its future decisions about payment reform.

Related resources:

• Replace Fee-for-Service with Bundled Payments in Medicare by David M. Cutler, Zeke Emanuel, and Topher Spiro
• The Senior Protection Plan by the CAP Health Policy Team
• Controlling Costs by Expanding the Medicare Acute Care Episode Demonstration by Maura Calsyn and Zeke Emanuel
• Payment Reform Action Plan: Meeting the New Medicare Payment Reform Target by Zeke Emanuel, Allyson Schwartz, Topher Spiro, and Thomas Huelskoetter
• A Strategy for Medicare Payment Reform by Topher Spiro, Maura Calsyn, and Meghan O’Toole

For more information on this topic or to speak with an expert, contact Liz Bartolomeo at [email protected] or 202.481.8151.