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CJR is a payment model being tested for episodes of care related to total knee and total hip replacements (MS-DRG 469 and 470) under Medicare. One track of the CJR model qualifies as an Advanced APM under QPP.
The model began April 1, 2016, was extended, and will run through December 31, 2024. CJR holds participant hospitals financially accountable for the quality and cost of an episode of care and incentivizes increased coordination among participating hospitals, physicians, and postacute care providers such as physical therapists. An episode of care begins with a patient’s hospital admission, continues upon hospital discharge, and ends 90 days postdischarge to cover the patient’s complete period of recovery.
As of August 2023, about 321 hospitals in various metropolitan statistical areas are participating in CJR. Physical therapists in these areas may be impacted.
Take a moment to learn about the model and determine if you should be thinking of marketing your practice to a CJR program.
Step 1: Understand CJR
Every Medicare total hip and total knee replacement procedure within the designated areas will be administered through CJR, including rehabilitation components of the episode of care. But even if you don't practice within a CJR area, similar models are sure to follow this lead, and there will be opportunities for physical therapist practices at large to be involved. Get a jump on the trend and use these resources to understand the implications of CJR and other bundled payment models.
Step 2: Determine if Becoming a CJR Collaborator Is Right for Your Practice
All total knee and total hip replacement procedures in the selected areas will be included under the CJR model. You can choose to actively become a collaborator under the CJR model or passively see these patients under your traditional payment structure. There are several details PTs need to consider before becoming a collaborator.
Step 3: Understand the Contracting Process
Becoming a collaborator in the CJR model will require contracting with a participating hospital(s). APTA has created a contracting toolkit that can be used in conjunction with APTA's managed care contracting toolkit that will help you identify important contracting considerations.
Questions regarding CJR should be sent to advocacy@apta.org.