The Centers for Medicare & Medicaid Services has proposed a Comprehensive Care for Joint Replacement payment model to improve patient outcomes from hip and knee replacement surgery, the agency announced July 9.

Under the proposed rule, the hospital in which the surgery takes place would be responsible for cost and quality of care from the time of surgery through 90 days after the procedure, or an “episode” of care. Then, based on cost performance and the quality of care delivered, the facility would either receive a financial reward or be required to repay Medicare for a portion of the costs, CMS said in a statement.

“This payment would give hospitals an incentive to work with physicians, home health agencies, and nursing facilities to make sure beneficiaries receive the coordinated care they need with the goal of reducing avoidable hospitalizations and complications,” the agency said.

The new model is an effort to improve the lack of coordinated care that may lead to postsurgery complications and high readmission rates in Medicare beneficiaries who receive these procedures.

“Joint replacements are the most commonly performed Medicare inpatient surgery and their utilization is predicted to continue to grow,” CMS said. “They can require long recoveries that may include extensive rehabilitation or other post-acute care, which provides many opportunities to reward providers that improve patient outcomes.”

Read the proposed rule here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-17190.pdf

mrajaraman@frontlinemedcom.com

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