Questions have arisen as to how the end of the original Bundled Payments for Care Improvement (BPCI) initiative affects participants that also happen to be located in a mandatory Metropolitan Statistical Area (MSA) for the Comprehensive Care for Joint Replacement model (CJR), as well as precedence regarding CJR and the new BPCI Advanced model. The Centers for Medicare & Medicaid Services (CMS) recently provided guidance for participating hospitals on these matters.
- According to CMS, clinical episodes in the BPCI initiative continued to have precedence over CJR clinical episodes until September 30, 2018, the final day of the initiative. Hospitals participating in the BPCI initiative that are located in a mandatory MSA became CJR participant hospitals as of October 1, 2018.
- Hospitals located in a mandatory MSA are not eligible to participate in BPCI Advanced for CJR episodes. However, they may participate in BPCI Advanced for non-CJR episodes.
- Under BPCI Advanced, the order of precedence will reverse and all CJR episodes (in either mandatory or voluntary MSAs) will have precedence over BPCI Advanced lower extremity joint replacement episodes.
Participating hospitals with questions regarding these changes or other issues can e-mail CJRSupport@cms.hhs.gov.
The MedBen Analytics reporting platform has provided actionable insights to both BPCI and CJR participants since 2015. If your hospital participated in the BPCI initiative and has questions about the transition to the CJR model, or if you are interested in viewing a demo of our current reporting platform, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email medbenanalytics@medben.com.