Comprehensive Care for Joint Replacement (CJR)

Quality Measures

Quality Measures

Quality Measures

• CMS is implementing a composite quality score to determine eligibility for reconciliation payments and to potentially reduce the discount factor applied to episode spending when determining the amount of repayment or reconciliation payment.

Quality Measures

The composite quality score is based on three weighted measures:

1. Hospital-level RSCR following elective primary THA and/or TKA

2. HCAHPS Survey

3. THA/TKA voluntary PRO and limited risk variable data submission

Quality Measures

Quality Measure Weight Score Range

Hospital-level RSCR following elective

primary THA and/or TKA

50% 0.00 – 10.00

HCAHPS Survey 40% 0.00 – 8.00

THA/TKA voluntary PRO and limited

risk variable data submission

10% 0.00 – 2.00

The first two measures listed are

mandatory; the third is optional.

The mandatory measures are

already being reported to CMS

by IPPS hospitals under existing

quality reporting programs, and

the data is published on

hospitalcompare.gov.

Quality Measures

• For the hospital-level RSCR following elective primary THA and/or TKA and the HCAHPS Survey measures, CMS will assign a score based on the hospital’s performance percentile.

Quality Measures

• For the optional measure, hospitals will receive two points if the data is successfully submitted and zero points if not.

• The composite quality score has a maximum value of 20.

Quality Measures

• Hospitals can also earn quality improvement scores equal to 10% of the total available points for the mandatory measures as a result of an increase over the previous performance year by at least three deciles on the performance percentile scale.

Quality Measures

• Hospitals are placed in a quality category based on their final composite quality score as follows:

Composite Quality Score Quality

Category

Less than 4.0 Below

Acceptable

Greater than or equal to 4.0 and less than 6.0 Acceptable

Greater than or equal to 6.0 and less than or

equal to 13.2

Good

Greater than 13.2 Excellent

Quality Measures

• Hospitals must have a quality score of at least “Acceptable” to be eligible for reconciliation payments (gainsharing).

Quality Measures

• Hospitals must have a quality score of at least “Good” to be eligible for quality incentive payments.

Quality Measures

• A quality incentive payment is not a separate payment; CMS implements it as a reduction in the hospital's effective discount factor when calculating the hospital’s target prices, thereby increasing the possibility of episode spending coming in below the target price.

Quality Measures

• These incentive payments (discount factor reductions) have no impact on any incentive programs or add-on payments under other existing Medicare payment systems.

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