The Centers for Medicare and Medicaid Services announces it is proposing a new payment model to hold hospitals accountable for the quality of care they deliver to Medicare beneficiaries undergoing hip and knee replacement surgeries.

According to a news release from the US Department of Health and Human Services, hip and knee replacement surgeries are some of the most common surgeries that Medicare recipients receive, and the quality of care and the cost of these procedures vary greatly among providers and locations.

The Comprehensive Care for Joint Replacement payment model being proposed reportedly supports improvements to the quality of care that Medicare patients receive, from surgery through recovery, per the release.

“By focusing on episodes of care, rather than a piecemeal system, hospitals and physicians have an incentive to work together to deliver more effective and efficient care,” says Health and Human Services Secretary Sylvia M. Burwell, in the release.

“This model will incentivize providing patients with the right care the first time and finding better ways to help them recover successfully. It will reward providers and doctors for helping patients get and stay healthy,” she continues.

The release explains that through the proposed 5-year payment model, healthcare providers in 75 geographic areas would continue to be paid under existing Medicare payment systems. However, the hospital where the hip or knee replacement takes place would be held accountable for the quality and costs of care for the entire episode of care—from the time of the surgery through 90 days after discharge.

Depending on the hospital’s quality and cost performance during the episode, the hospital may receive an additional payment or be required to repay Medicare for a portion of the episode costs. As a result, hospitals would have an incentive to work with physicians, home health agencies, and nursing facilities to make sure beneficiaries get the coordinated care they need, with the goal of reducing avoidable hospitalizations and complications, the release continues.

Hospitals would receive tools—such as spending and utilization data and sharing of best practices—to improve the effectiveness of care coordination, the release notes.

According to the release, there will be a 60-day comment period, during which stakeholders and the public can submit comments regarding the new proposal. The deadline to submit comments is September 8, 2015.

The proposal is available at and can be viewed at starting July 14, 2015, per the release.

[Source: US Department of Health and Human Services]