The recent implementation of the Comprehensive Care for Joint Replacement (CJR) program, the first mandatory alternative payment model (APM), signals an unprecedented escalation in Medicare’s efforts to hold hospitals accountable for acute care costs. The CJR program is likely a harbinger of mandatory payment reforms that will affect many surgical professionals. In fact, the Centers for Medicare and Medicaid Services (CMS) has already proposed a new mandatory APM for coronary artery bypass grafting to launch in July 2017.1 However, the CMS approach to APMs, as illustrated by CJR, has important limitations that may have unintended negative consequences. As mandatory APMs expand beyond joint replacement, surgeons and hospital leaders should understand the details and drawbacks of the program, consider how its design and implementation could be improved, and bear these lessons in mind as APMs come to their own fields.
Nathan H, Dimick JB. Medicare’s Shift to Mandatory Alternative Payment ModelsWhy Surgeons Should Care. JAMA Surg. Published online November 23, 2016. doi:10.1001/jamasurg.2016.4005