EHRs, interoperability integral to proposed joint replacement payment model

The Centers for Medicare & Medicaid Services continues to use payment reform to direct more providers to use electronic health records, this time in its proposed new rule changing how hospitals would be paid for hip and knee replacement.

The rule, published in the Federal Register July 14, creates the Comprehensive Care for Joint Replacement (CCJR) payment model. It would test bundled payment and quality measures to improve quality and coordination of care and hold hospitals accountable for the quality of care provided in these joint replacements from surgery through 90 days after a patient's discharge. Providers still would be paid on a Medicare fee-for-service basis, but the cost of an episode--called an actual episode payment--would be reconciled to CMS' target price; hospitals that didn't meet it would need to repay CMS.  

CMS contemplates that EHRs and data sharing will be integral to hospitals' success.

"We believe that use of certified health IT tools and the interoperable exchange of health information is a critical capability for CCJR model participants to be able to deliver the high-quality care and effective coordination across settings that will be required to demonstrate success under the model," CMS says in the proposed rule. "Moreover, we believe that it will be important to incentivize adoption and use of these enabling technologies among model participants including post-acute care providers, by linking these activities to participant eligibility to receive reconciliation payments."

CMS states that the model does not include a measure for certified health IT use in the first performance year, but is seeking comment on how to incorporate such a measure after that. The rule asks for comments on whether successful Meaningful Use attestation is the most appropriate quality measure to assess a hospital's performance or use of health IT, and what other measures may be used.

The five-year model will be instituted in 75 geographic areas.

The proposed payment model, designed by the CMS Innovation Center, is the latest that places a heavy emphasis on EHRs and interoperability. However, some of the other new programs were more voluntary in nature than this rule.

Comments on the rule are due by Sept. 8.

To learn more:
- read the proposed rule (.pdf)

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