CMS proposes adding outpatient hip & knee replacements to its comprehensive care model

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A new proposed rule to the comprehensive care for joint replacement model from CMS aims to add outpatient hip and knee replacements to the definition of an episode of care, among other changes.

The comprehensive care for joint replacement model aims to reduce Medicare costs by testing whether bundled payments and quality measures for hip and knee replacements encourages physicians, hospitals and other providers to work together to improve care.

Aside from updating the definition to include outpatient hip and knee replacements, CMS proposed changing the basis for the target price of a procedure to the most recent year of claims data instead of basing the price on three years of claims data. It also proposed including more risk adjustments to target procedure prices and extending the program for three more years.

The comprehensive care for joint replacement model was established in April 2016. CMS is accepting comments on the proposed changes until April 20.

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