Congressmen Introduce Bill to Delay Implementation of CJR Model

U.S. Reps. Tom Price (R-Ga.) and David Scott (D-Ga.) have introduced legislation to delay implementation of the Comprehensive Care for Joint Replacement (CJR) model, a bundled payment program mandated by the Centers for Medicare and Medicaid Services (CMS) and set to start on April 1. The model affects hospitals in 67 geographical areas and targets the most common inpatient surgeries for Medicare beneficiaries: hip and knee replacements, both elective and non-elective, as well as other lower extremity joint replacement procedures and the repair of hip fractures.

H.R. 4848, titled, the “Healthy Inpatient Procedures (HIP) Act,” would delay CJR implementation until Jan. 1, 2018, ensuring that physicians, hospitals, and post-acute care providers have adequate time to prepare for the onset of this complex payment system.

“AAOS commends Chairman Price and Congressman Scott on the introduction of H.R. 4848,” said American Academy of Orthopaedic Surgeons (AAOS) President Gerald R. Williams, Jr., M.D. “The CJR model mandated by CMS requires comprehensive planning and coordination between hospitals, physicians, and post-acute care providers, as well as complete infrastructural support. While AAOS embraces initiatives that improve quality and lower cost, it is important that all stakeholders have adequate time to prepare for this kind of substantial change to our health care delivery system in order to avoid any disruption to normal patient access and care patterns.”

Under the model, called the Comprehensive Care for Joint Replacement (CJR) model, the hospital in which the hip or knee replacement takes place would be accountable for costs associated with the entire episode of care – from the time of the surgery through 90 days after discharge. According to CMS, this alternative payment model will contribute to the Medicare goals set by the Obama Administration of having 30 percent of all Medicare fee-for-service payments made via alternative payment models by 2016 and 50 percent by 2018.

“This new, mandatory payment model handed down from CMS comes with tremendous risk and complexity for patients and health care providers. Rushing its implementation would be unreasonable and potentially detrimental to patients and their quality of care,” Price said. “At the very least, a delay in implementation is warranted to give all involved time to better assess, review, and weigh the impact and consequences of this proposal and more adequately prepare so patients are protected.

“I am excited to be joining Dr. Tom Price on this common sense piece of legislation. With the current health care system rapidly evolving to address the changing nature of patient care, physicians need time to adjust to changes in payment models,” Scott said. “H.R. 4848, the Healthy Inpatient Procedures (HIP) Act, addresses this pressing issue by delaying the CJR implementation until 2018. This delay will ensure that both doctors, hospitals, and post-acute care facilities are able to implement these changes without harming or reducing patient care. I look forward to working across the aisle to pass this critical legislation.”

Forcing CJR participants to begin implementing the model next month could cause widespread startup and integration problems, “making it more difficult to achieve improvements in patient quality of care as well as costs,” AAOS said.

“AAOS members have proven they are leaders in developing, implementing, and evaluating episode of care payments,” stated Thomas C. Barber, M.D., chair of the AAOS Council on Advocacy. “But the patient must be the primary focus of all initiatives. Without a delay, many CJR participants may face startup and integration problems, making it more difficult to achieve improvements in patient quality of care as well as in costs. We thank Chairman Price and Congressman Scott for introducing H.R. 4848 to address this important issue and we look forward to working together to improve the care of all musculoskeletal patients in the United States.”

The bill was referred to the U.S. House of Representatives Ways & Means Committee and the Energy & Commerce Committee.