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March 29, 2016



Price, Scott Introduce CJR Delay Legislation

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Price, Scott Introduce CJR Delay Legislation

Last week, Reps. Tom Price (R-GA) and David Scott (D-GA) 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, 2016. 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, the Healthy Inpatient Procedures (HIP) Act, would delay CJR implementation until January 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,” stated Gerald R. Williams, Jr., MD, President, American Association of Orthopaedic Surgeons (AAOS). “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.”

In a press release announcing the legislation, Price noted that the model comes with tremendous risk and complexity for patients and health care providers, adding that rushing its implementation “would be unreasonable and potentially detrimental to patients and their quality of care.” He suggested that 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. Scott echoed Price’s concerns, commenting that 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.” According to Scott, a delay until 2018 of the payment model will ensure that both doctors, hospitals, and post-acute care facilities are able to implement these changes without harming or reducing patient care.

“AAOS members have proven they are leaders in developing, implementing, and evaluating episode of care payments,” stated Thomas C. Barber, MD, 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.”

In September 2015, Price and Scott, along with 59 fellow members of Congress, sent a letter to CMS Acting Administrator Andrew Slavitt as well as Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer Patrick Conway, MD, MSc raising specific concerns with CMS’ CJR payment proposal and asking important questions about how the new model might affect access to care for the sickest patients, the needs of small and rural hospitals, challenges in coordination of care delivery, and anticipated difficulties for care providers. A copy of the letter is available here.

Read more about CJR and other Medicare payment changes on the AAOS website at