Comprehensive Care for Joint Replacement (CJR)

Calculating Episode Spending

Calculating Episode Spending

Calculating Episode Spending

• CMS calculates the spending for an episode by summing payments for qualified hospital discharges from MS-DRG 469 and 470 and all subsequent related Part A and Part B care for 90 days post-discharge.

Calculating Episode Spending

• CJR episode spending includes payments to both participating and non-participating physicians, but excludes payments to physicians who have opted out of Medicare.

Calculating Episode Spending

• Capital payments are included in CJR episode spending calculations.

Calculating Episode Spending

• If a payment is made for a period that extends beyond the end of the CJR episode, it will be prorated so that only the portion attributed to the period during the episode is included in the episode spending.

Calculating Episode Spending

• If a payment was made for home health services that started before the episode and ended during the episode, it will also be prorated.

Calculating Episode Spending

• CMS estimates that 50% of CJR episode expenditures will be for inpatient care, 15% for physician payments and 35% for other services and providers.

To download the full CJR report, click on the image below