QUESTION:          Our hospital is located in one of the Metropolitan Statistical Areas identified in the Medicare Comprehensive Care for Joint Replacement (“CJR”) model and has, thus, been selected for participation. Could you tell us about the quality measures involved in the CJR model and how they will affect our payment?

ANSWER:             There are two quality measures which will be used in the CJR model: (1) hospital-level risk-standardized complication rates following hip and knee replacements; and (2) the Hospital Consumer Assessment of Healthcare Providers and Systems (“HCAHPS”) Survey. A composite quality score will be calculated based on the sum of quality performance points based on these measures. The quality performance points are given based on various percentiles which measure a participant hospital’s performance percentile relative to the national distribution of all hospitals’ performance on that measure. For example, if your hospital is at or above the 90^th percentile for the complication rate measure, your hospital will be given 10 points. If your hospital is at or above the 90^th percentile for the HCAHPS measure, your hospital will be given eight points. You can also earn “quality improvement points,” if there is an increase in either of the quality measures from the previous performance year. An additional two points may be earned for submitting certain “voluntary” data on patient-reported outcomes. Hospitals will then be assigned to quality categories based on their composite scores. Hospitals that have a composite quality score of greater than or equal to six and less than or equal to 13.2 will be assigned to the “Good” quality category. Hospitals with a composite quality score of greater than 13.2 will be assigned to the “Excellent” quality category. This is important because hospitals assigned to either the “Good” quality category or “Excellent” quality category are eligible for, among other things, enhancements to their reconciliation payments under the CJR model. For example, hospitals in the “Excellent” quality category are eligible for a quality incentive payment at reconciliation that equals 1.5 percent of the hospital’s benchmark price in performance year one. This changes the hospital’s effective discount percentage included in the target price at reconciliation, resulting in an opportunity for higher payments at reconciliation.