Physician Practice

CMS rolls back joint replacement program, jettisons episode payment programs

Physician Practice Insider, August 21, 2017

CMS is preparing to cancel four mandatory episode payment models for common cardiac and orthopedic conditions that were due to begin in January, according to a proposed rule issued Aug. 15.

Within the same proposal, the agency also revealed plans to dramatically dial back the comprehensive care of joint replacement (CJR) program that has been in effect since April 2016.

The deleted payment models include:

  • An episodic payment model for surgical treatment of hip and femur fractures,
  • Two separate episodic payment models for coronary artery bypass grafts and care of patients with acute myocardial infarction, and
  • An incentive payment program for cardiac rehab services.

For CJR, the agency proposed to reduce the number of geographic areas where hospitals are required to participate from 67 to 34. Low-volume and rural hospitals would no longer be required to participate in CJR in all of the geographic areas. Participation in CJR would be voluntary in the 33 geographic areas where it is no longer required.

The agency also proposed some tweaks to the CJR program, such as adding facility practice expense relative value units (RVUs) to CJR telehealth codes, and providing a means for CJR-participating clinicians to be considered qualifying participants in advanced alternate payment models under Medicare’s Quality Payment Program.

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