If a facility cannot participate in the CJR due to their star rating, will they still be able to treat hips and knees under the PPS system?

A: To be clear SNFs are not prohibited from accepting CJR patients due to their star rating. If the hospital is located in one of the MSAs where the CJR model is mandatory all knee and hip replacements (DRG 469 and 479) will be part of this model. When the patient transfers to a SNF post hospitalization the SNF is reimbursed under the PPS system under the CJR model and payment are reconciled retrospectively.

In order to access Medicare benefits the beneficiary must have a 3 day qualifying hospital stay. Under the CJR model there is a waiver of the 3 day stay requirement that applies only to SNFs that attain a 3 star rating or higher for 7 of the 12 preceding months. If your facility does not meet this criteria then you will not be able to admit any beneficiaries who do not have a 3 day qualifying stay.

In addition, under the CJR model hospitals would prefer to collaborate with facilities with a 3 star rating or higher and will likely not want to enter into relationships with facilities who do not meet this criteria. The end result may be significantly fewer lower extremity joint replacements referral to facilities with lower star ratings.

It is important to point out that the beneficiary retains the right to select the provider of choice in this program. This being said, in the bundled payment system hospital case managers have been known to provide Nursing home compare star rating information to patients when providing them information about local facilities to assist in making their choice.