Yesterday CMS issued a proposed rule for the Comprehensive Care for Joint Replacement (CCJR) a proposal to require all episodes of Major Joint Replacement in 75 MSAs to be paid on a "bundled" basis. This is a significant step from the voluntary Bundled Payment for Care Improvement program in that it requires virtually all hospitals (but not physicians or other providers) to be financially responsible for all of the care of these patients for 90 days after discharge. Hospitals in 75 Metropolitan Statistical Areas (MSAs) would be affected. The bundle definition is quite similar to that of the BPCI Major Joint Replacement bundles, but incorporates quality metrics into the payment methodology.
We'll have further analysis about this program shortly, and the proposed rule can be found on this website.