‘A Unique Opportunity for Home Health Providers’: CMS Extends CJR Model

The U.S. Centers for Medicare & Medicaid Services (CMS) has extended the Comprehensive Care for Joint Replacement (CJR) payment model. That’s welcome news for home health operators, as CJR has been a key program for participating agencies since its implementation.

Introduced in 2016, CJR essentially allows CMS to hand out bonuses or inflict payment penalties to providers based on how well certain hip- and knee-replacement patients are cared for.

The model has successfully been able to reduce health care spending, in large part thanks to an increase in home health care for CJR patients. CJR was one of the early departures from fee-for-service reimbursement, instead providing fixed payments for hip and knee procedures plus follow-up care.

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That follow-up care is where home health agencies factor into the equation.

“The extension of the CJR model is a sure sign that CMS is committed to implementing regulations and pay practices that incentivize collaboration across the continuum,” John Rabbia, a senior manager at Simione Healthcare Consultants, told Home Health Care News in an email. “It ensures that patients are receiving the right level of care, in the right setting, at the right time.”

Simione Healthcare Consultants is a Connecticut-based company that provides clinical, financial, growth support and IT services to home health and hospice agencies.

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In a final rule published Monday, CMS extended the cost-cutting CJR program by another three years, through December of 2024. Originally, when it was set to expire at the end of 2020, the hope was that it would be extended through 2023.

Nearly 70 markets are now active in the model, which lends a bundled payment to providers based on the period between discharge and the 90 days after.

Broadly, CJR has been changed a bit through the extension process, however. Rural and low-procedure-volume hospitals are excluded, as well as providers who volunteered to participate in the earlier version of the payment model. Additionally, coverage will be expanded to include both in-patient and outpatient surgeries for hips and knees.

“The expansion of the CJR model to include procedures performed in the outpatient setting is a strong signal that providers in the post-acute space should be evaluating all of their partnerships to proactively identify opportunities to collaborate more tightly with referral sources and post-acute partners,” Rabbia said.

The target price calculation will also now be based on the most recent year of claims data — not the three years prior. The CJR reconciliation process has likewise been adjusted, with CMS turning the two reconciliation periods into one, which will take place six months after the close of a performance year.

Those changes, among others, will be implemented on Oct. 1.

“The CJR model has created a unique opportunity for home health providers to demonstrate their value by disrupting the typical discharge plan of joint-replacement patients from hospital, to sub-acute rehab, to home,” Rabbia said. “Many hospitals have revised the criteria they use to determine the most appropriate discharge disposition for a post-acute patient. Home health agencies have been critical players in this shift by educating hospitals in the true level of patient acuity that can safely be managed in the home setting.”

Additionally, the model has provided an opportunity for home health agencies to build trust with referral partners by preventing adverse outcomes such as surgical site infections and rehospitalizations, he added.

“It’s been the perfect foundation on which to build other value-based relationships that rely heavily on tight coordination of care and strategic utilization of health care resources,” Rabbia said.

CMS is estimating that its final rule will save over $200 million dollars for Medicare over the additional three years.

While other CMS innovation remains on hold as President Joe Biden’s administration reviews various programs and payment models, the extension of CJR could be a signal that the emphasis on value- and home-based care will continue.

“I think the initial success of the CJR model — coupled with CMS’s willingness to extend and expand it — means that post-acute providers will have more opportunities to serve higher acuity patients in the home setting,” Rabbia said.