CMS finalized the nationwide rollout of CJR-X, bundled payment model for joint replacements. The move is intended to reshape financial accountability for orthopedic surgeons and hospitals.
“Knee, hip, and ankle replacements are important for helping seniors preserve their mobility and overall well-being,” said Mehmet Oz, MD, CMS administrator. “Expanding the joint replacement pilot program to support more of our seniors will help match financial incentives in Medicare with improved health outcomes, safeguard taxpayer resources, and ensure patients experience a positive, comprehensive care journey throughout the surgical process.”
Here’s what surgeons need to know.
1. CJR-X becomes mandatory nationwide starting Jan. 1, 2028. The model is part of the fiscal year 2027 Inpatient and Long-Term Care Hospital Prospective Payment System final rule and marks the first time CMS has made an episode-based payment program both mandatory and nationwide.
2. The episode covers surgery through 90 days of recovery. Hospitals are financially accountable for Medicare spending on hip, knee and ankle replacements, from the procedure and hospitalization through 90 days post-discharge, including follow-up care such as physical therapy.
3. Hospitals carry the financial risk, but surgeons drive the coordination. Episode-based payments push hospitals, surgeons and post-acute providers to collaborate on recovery plans, since avoidable readmissions, complications and unnecessary post-acute services now count directly against the hospital’s bottom line.
4. Patients keep their choice of physician under the model, but surgeons and the hospitals they operate in will face new financial incentives to tighten coordination across the full joint replacement episode.
5. The predecessor model saved Medicare more than $100 million. CMS Innovation Center Director Abe Sutton said CJR-X builds on the original Comprehensive Care for Joint Replacement Model, which ran from April 2016 through December 2024 and generated Medicare savings while maintaining care quality.
6. ASCs aren’t direct participants, but they aren’t insulated either. Acute care hospitals are the formal CJR-X participants, not ambulatory surgery centers.
7. Some hospitals are exempt. Hospitals participating in the Transforming Episode Accountability Model, those in Maryland, and those not paid under both the Inpatient and Outpatient Prospective Payment Systems may be excluded from CJR-X.
8. The same rule raises inpatient pay 2.3% for fiscal 2027. CMS finalized the payment rate increase for inpatient and long-term care hospitals alongside the CJR-X mandate, reflecting updated hospital cost data.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.