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New CMS proposed rule for TKR could negatively impact CJR participants: 6 things to know

By: Megan Wood

DataGen was recently featured in an article fromĀ beckersspine.com.

DataGen, an analytics and modeling organization, assessed CMS’ recently released 2018 Outpatient Prospective Payment System proposed rule.

Here are six things to know:

1. The OPPS rule proposes to remove outpatient knee replacement procedures from the inpatient-only list, meaning surgeons could perform these procedures in the outpatient setting.

2. This proposed rule’ consequence involves removing these TKR patients from the Comprehensive Care for Joint Replacement program.

3. DataGen reports the OPPS would alter the target away from CMS’ original assessment, disadvantaging CJR participants. DataGen’s Director of Informatics Darcie Hurteau explains: “CMS uses three years of historical data to set 90-day episode payment targets for each participant in the CJR program. The less complex, lower cost patients were included when CMS established their historical baseline data. This means the targets CMS will use for the remaining more complex patients (i.e., more expensive 90-day bundle) will be based on a different mix of patients than the patients who will remain in the program.”

4. Ideally, Ms. Hurteau says CMS would adjust the target to represent the patient mix after certain patients move to the outpatient setting.

5. She suggests CJR participants analyze their data to understand the impact of the proposed OPPS rule.

6. Those who disagree with the proposed OPPS rule may submit comment to CMS by Sept. 11.