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Feds Propose Hip and Knee Replacement Initiative using Bundled-Payment Model  

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services’ Innovation Center (CMS Innovation Center) has announced a proposal, through the notice and comment rulemaking process of a new model for Medicare beneficiaries who undergo hip and knee replacements.

This model, called the Comprehensive Care for Joint Replacement (CCJR) Model, would test bundled payment and quality measurement for hip and knee replacements to encourage hospitals, physicians, and post-acute care providers (including home health agencies) to work together to improve quality and coordination of care throughout an entire episode of care, from the initial hospitalization through recovery.

With publication of a proposed rule, CMS is seeking input and comments from the public, including beneficiaries, health care providers, and other stakeholders.

Under this proposed model, the hospital in which the hip or knee replacement takes place would be accountable for the costs and quality of care from the time of the surgery through 90 days after — what’s called an “episode” of care.

Depending on the hospital’s quality and cost performance during the episode, the hospital would either earn a financial reward or be required to repay Medicare for a portion of the costs. According to CMS, this payment would give hospitals an incentive to work with physicians, home health agencies, and nursing facilities to make sure beneficiaries receive the coordinated care they need with the goal of reducing avoidable hospitalizations and complications.

Hospitals would have additional tools — such as spending and utilization data and sharing of best practices — to improve the effectiveness of care coordination.

This model would be in 75 geographic areas throughout the country and most hospitals in those regions would be required participate.

The proposal is available at and can be viewed at starting July 14, 2015.

The deadline to submit comments is September 8, 2015.

For more information, visit