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Newly Proposed Bill to Delay CJR Is Predictable and Pedestrian

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While some of us were disappointed to see the sleepy bill that proposes to further delay the Comprehensive Care for Joint Replacement (CJR) bundled payment initiative, let’s be real: given how long it took us to rip off the Band-Aid with SGR, it was predictable.

The recently proposed legislation to put off CJR until 2018 suggests that Congressmen Tom Price (R – Georgia) and David Scott (D – Georgia), as well as the American Academy of Orthopaedic Surgeons (AAOS), are determined to maintain the status quo. Price and Scott’s bill was sent to the House Ways and Means Committee, where it is expected to be read this week. And although the CJR initiative went into effect on April 1, the bill could still disrupt its implementation.

While the CJR model is the first mandatory bundled payment issued by CMS’s Center for Medicare & Medicaid Innovation, the concept of bundling payments for hip and knee replacements is nothing new. This reimbursement construct has been the subject of numerous tests and validation studies for more than 20 years; and there is mounting evidence to support it as a viable alternative to the costly and immoral over-testing and over-treating of conditions through the fee-for-service model. Nor should the announcement about mandatory participation have come as a surprise. CMS introduced the expansion of bundles via CJR last November and called for implementation starting this April.

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What Congressman Price and Scott seem to have missed is that with CJR, CMS has actually built in a “grace period” allowing for physicians and hospitals to bear no risk until January 2017. This was an effort to address concerns raised during the comment period related to the time necessary for organizations to put mechanisms in place to effectively coordinate care for joint replacement patients – some of the same concerns cited by Price and Scott. The fact that we as an industry do not already have in place some level of rudimentary care coordination is a disgrace.

Congressmen Price and Scott also must have forgotten that the cost for healthcare in the United States is double that of comparable nations, despite our having the lowest life expectancy and highest infant mortality rates among the wealthiest nations in the world. The Congressional Budget Office estimates that bundled payments could offer spending relief for Medicare to the tune of $19 billion (that’s “billion,” with a “B”) between 2010 and 2019. Even over a 5-year period, the cost relief estimates to Medicare for CJR are $343 million.

This bill also represents a profound miss for the AAOS, which, in backing the proposed legislation, lost not only an opportunity but also an obligation to lead the innovation necessary to transform healthcare. The AAOS, more than any other organization, knows this approach has not been rushed, contrary to Price and Scott’s claims.

If we really want to revolutionize healthcare – rather than stifling innovation by sitting this one out until 2018 – then hospitals, physicians, policy makers, and innovators must continue the work that is under way all over this country. With the health of our people and the well-being of our economy hanging in the balance, this is no time for delay.

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