CMS Grants More Flexibility for Telemedicine Services Under Bundled Payment Model for Joint Replacements

This week, the Centers for Medicare & Medicaid Services (CMS) unveiled a bundled payment model for hip and knee replacements that will enable Medicare providers to use telemedicine services more extensively.

Known as the Comprehensive Care for Joint Replacement (CJR), the model, which is set to begin on April 1, will hold hospitals accountable for the quality of care they deliver to Medicare fee-for-service beneficiaries for hip and knee replacements from surgery through recovery.

The finalized Medicare payment model has telemedicine implications as CMS is waiving Medicare’s customary requirements that the beneficiary live in a rural area and that the location of the telemedicine services provided must be at a medical facility and not the patient’s home.

In the final rule, CMS waives the geographic and originating site requirements that limit telehealth payments.

CMS wrote in the final rule, “This waiver would allow providers and suppliers furnishing services to CJR beneficiaries to utilize telemedicine for beneficiaries that are not classified as rural and to allow the greatest degree of efficiency and communication between providers and suppliers and beneficiaries by allowing beneficiaries to receive telehealth services at their home or place of residence. In the proposed rule, we stated our belief that these waivers are essential to maximize the opportunity to improve the quality of care and efficiency for lower extremity joint replacement (LEJR) episodes under CJR. “

According to CMS, the CJR model is expected to save the Medicare program as much as $343 million over five years by bundling payments to hospitals to perform hip and knee replacements.