On November 24, the Centers for Medicare and Medicaid Services (CMS) published a final rule that would bundle payments for knee and hip replacements. The Comprehensive Care for Joint Replacement (CCJR) Model for Acute Care Hospitals would bundle all related care for a 90-day episode. CCJR resembles Model 2 of Bundled Payments for Care Improvement (BPCI), CMS' pilot program for bundled payment. But unlike BPCI, any hospital in 67 Metropolitan Statistical Areas (MSA's) would be required to participate.


CMS delayed the implementation of the rule from January 1 to April 1, 2016. CMS also changed the number of geographic areas included in the model from 75 to 67. For a very good and detailed 7-page summary of the rule, click here. Click here to read the 1,018-page rule.
The new rule is also granting some of the fraud and abuse waivers providers asked for in their comment letters. Click here for the waivers summary.
Medicare providers can use telemedicine much more extensively in this bundled payments program. CMS is waiving many of Medicare's usually restrictive requirements on telemedicine's use in the program. The final rule also helps beneficiaries receive technology incentives, for example a monitoring device, without violating federal kickback laws. Providers are limited in their incentives to $1,000 per beneficiary per episode. Under a change in the final rule, providers are allowed to repossess any good valued at more than $100. It was $50 in the rule proposed this summer.
The 18-member GOP Doctors Caucus in the House of Representatives is reportedly sending a letter to Speaker Paul Ryan to ask for end-of-year legislation that would further delay the bundled payments program for hip and knee surgeries. The letter is also expected to call for a delay in meaningful use implementation.


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