United States: CMS Revises CJR Program, Cancels Cardiac Bundles

On Aug. 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule seeking to reduce mandatory participation requirements in the Comprehensive Care for Joint Replacement (CJR) program for hospitals and to eliminate the episode payment models (EPM) and cardiac rehabilitation (CR) incentive payment model before their scheduled effective date of Jan. 1, 2018.

Published in the Federal Register on Aug. 17, 2017, the proposed rule will cut the number of Metropolitan Service Areas (MSAs) with mandatory hospital participation about in half, with 34 of the original 67 MSAs still required to participate. In those 34 MSAs, low-volume and rural hospitals may choose to participate on a voluntary basis, informing CMS of their intent to participate in the program between Jan. 1, 2018 and Jan. 31, 2018.

The hospitals in the remaining 33 MSAs for CJR may participate on a voluntary basis, and these MSAs include the St. Louis, Kansas City, and Columba, Missouri MSAs, the Albuquerque, New Mexico MSA, and the Indianapolis, Indiana MSA. These hospitals must also inform CMS of their intent to participate in the program between Jan. 1, 2018 and Jan. 31, 2018.

Tables detailing mandatory and voluntary MSAs for the CJR program can be found here.

In addition to the modifications to the CJR program, CMS' proposed rule seeks to eliminate the EPM program, which bundled reimbursement for acute myocardial infarction and coronary artery bypass graft care episodes. Accompanying that change, the proposed rule will also eliminate the CR program, which encouraged the use of cardiac rehabilitation services during an EPM cardiac episode.

The proposed rule follows repeated delays to the effective date of the EPM and CR models. In its proposed rule, CMS noted that "large mandatory episode payment model efforts" may inhibit later testing of future bundled payment models with volunteering providers, and that canceling the EPM and CR models would provide hospitals with the flexibility to test other bundled payment models on a voluntary basis.

Comments on the proposed rule may be submitted to CMS through Oct. 16, 2017. Information about the CJR program may be found here.

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