CMS’ Comprehensive Care for Joint Replacement Model Provides Opportunity for DME Suppliers

Posted on in VGM News, Growth Strategies


By: Dave Lyman, VGM Outcomes

In November of 2015, CMS finalized a new bundled payment initiative for hip and knee replacements. Titled “The Comprehensive Care for Joint Replacement (CJR) Model,” the initiative will provide additional payments to hospitals in 67 geographic areas that provide high quality care at lower costs. To achieve these standards, hospitals will be charged with organizing care coordination between physicians, home health agencies, skilled nursing facilities and DME suppliers. The program, scheduled to start on April 1, provides a great opportunity for DME suppliers to strengthen and establish relationships with hospitals.


Four hundred thousand Medicare beneficiaries receive hip and knee replacements that cost more than $7 billion for hospitalizations alone. The average Medicare expenditure for surgery, hospitalization and recovery ranges from $16,000 to $33,000, with some facilities trending toward the higher figure due to complications such as infections and implant failures. The CJR model was created as an incentive to hospitals, holding them accountable for patient outcomes and the cost of care.

According to CMS:

“The episode of care begins with an admission to a participant hospital of a beneficiary who is ultimately discharged under MS-DRG 469 (major joint replacement or reattachment of lower extremity with major complications or comorbidities) or 470 (major joint replacement or reattachment of lower extremity without major complications or comorbidities) and ends 90 days post-discharge in order to cover the complete period of recovery for beneficiaries. The episode includes all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries, with the exception of certain exclusions.”

DME Suppliers Should Connect with Hospitals to Join the CJR Model

It is important that the DME suppliers within the 67 geographic regions to connect with the hospitals to help in the coordination of care. As we all know, the DME supplier plays a vital role in the care continuum to prevent readmissions and promote healing.

The CJR model provides an opportunity for DME suppliers to look at new ways of doing business. Bundled payments, pay for performance and ACO models are not going away. DME suppliers must understand these models and incorporate them into their business model.

Here are four tips to get started:

  1. Learn more about this model, and decide if this fits your business plan.
  2. Write a proposal that demonstrates that your company provides high quality care. Include any outcomes data you’ve collected on patient satisfaction or hospital readmissions.
  3. Contact the case management department of your local hospital(s) to find out who is leading this project for their health system(s).
  4. Schedule a meeting with the chief medical officer (CMO) and the project lead to explain how your products and services help this initiative.

For more information about this model and a listing of the 67 geographic regions, go to

If you have questions, contact Dave Lyman at [email protected].