In the new Louisville Business First Legal Forum Column, BGD attorney Carmin D. Grandinetti discussed the CMS Comprehensive Care for Joint Replacement program. Read his advice below and don’t miss our monthly Legal Forum Column in Louisville Business First.


What do I need to know about the proposed CMS Comprehensive Care for Joint Replacement program?


In July, the Centers for Medicare & Medicaid Services (“CMS”) proposed a five-year bundled payment demonstration program for hip and knee replacement surgeries. The proposed CMS Comprehensive Care for Joint Replacement program is an alternative payment model requiring 800 hospitals in 75 test areas to bundle payments for most hip and knee surgeries that Medicare covers annually. CMS believes that requiring all the providers involved in the episode of care to accept and share the fixed payment will force better coordinated patient care, and result in better outcomes at a lower overall cost. 

If this paradigm shift continues, it will force providers to create integrated health care delivery systems (“IDSs”) that can handle all the types of patient care needed in connection with a specific health care procedure or episode of care, and will likely cause more consolidation among hospitals, physicians and long term care providers. An attorney can help providers navigate the many unique challenges and loss exposures associated with IDSs.