Proposed rule includes modification to CJR and Cardiac Care Bundled Payment Model

A new CMS Proposed Rule revises the Comprehensive Care for Joint Replacement Model (CJR) to potentially qualify as an Advanced Alternative Payment Model (APM) if participants meet requirements:

  1. Establish a new episode payment model (EPM) for hip/femur fracture treatment excluding lower extremity joint replacement (SHFFT)
  2. Establish a Cardiac Rehabilitation Incentive Payment Model, similar to CJR.

As currently proposed under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) rule, physicians can avoid Merit-Based Incentive Payment System (MIPS) and receive the automatic 5% APM bonus payment if they are participating in an Advanced APM. An APM qualifies as an Advanced APM if it meets three criteria.  First, the APM must provide for payment for professional services based on quality measures comparable to MIPS quality performance measures.  Second, the APM must require that participants bear risk for monetary losses of a more than nominal amount under the APM.  Third, the APM must require participants to use certified EHR technology (CEHRT). Read the summary prepared by Epstein Becker Green. Read the summary prepared by Epstein Becker Green.