First Mandatory Joint Replacement Bundled Payment Starts In April
CMS has released a final rule that would bundle payments for knee and hip replacements for 67 geographic areas. The Comprehensive Care for Joint Replacement (CCJR) Model for Acute Care Hospitals would bundle all related care for a 90-day episode. After receiving nearly 400 comments on the proposed rule, CMS delayed the implementation of the rule from January 1 to April 1, 2016. CMS also changed the number of geographic areas included in the model from 75 to 67. For a very good and detailed 7-page summary of the rule, click here. Click here to read the 1,018-page rule.
- The new rule is also granting some of the fraud and abuse waivers providers asked for in their comment letters. Click here for the waivers summary.
- Medicare providers can use telemedicine much more extensively in this bundled payments program. CMS is waiving many of Medicare's usually restrictive requirements on telemedicine's use in the program. The final rule also helps beneficiaries receive technology incentives, for example a monitoring device, without violating federal kickback laws. Providers are limited in their incentives to $1,000 per beneficiary per episode. Under a change in the final rule, providers are allowed to repossess any good valued at more than $100. It was $50 in the rule proposed this summer.
Chief Executive Officer, Chief Operating Officer, Crusader for lower healthcare cost
9 年This will be an interesting transition to say the least. I fully support cost containment measures and improving the quality of care and patient satisfaction. In my opinion, CMS is simply shifting the administrative burden of managing an entire episode of care to the hospitals. It will be the responsibility of the hospitals to negotiate payment structures with physicians for follow up care, the numerous home health providers in the community, physical therapy providers, and the list goes on. Facilities that are not in the mandated areas should take the next few years to plan wisely for what will become mandated for everyone, and find ways to decrease expenses, improve patient satisfaction and reduce complications and readmission rates sooner rather than later.