CMS expands CJR model
- CMS proposed expanding the Comprehensive Care for Joint Replacement (CJR) model nationwide under value‑based payment. - Experts call the expansion logical but warn hospitals will face significant implementation challenges. - The policy trend reinforces federal emphasis on coordination that could shift incentives toward integrated behavioral‑health services. (medcitynews.com)
Medicare is moving to make bundled payment for joint replacements a nationwide rule for most hospitals, starting October 1, 2027. (cms.gov) The Centers for Medicare & Medicaid Services proposed the expansion on April 10, 2026, through its fiscal 2027 inpatient hospital payment rule. The model, called CJR-X, would cover hip, knee, and ankle replacements for Original Medicare patients in inpatient and hospital outpatient settings. (cms.gov) Under bundled payment, Medicare sets one financial target for the surgery and the next 90 days of recovery instead of paying each provider separately without a shared budget. Hospitals in CJR-X would be accountable for the procedure, the hospital stay, physical therapy, and other follow-up care during that 90-day episode. (cms.gov) CMS is leaning on results from the first version of the model, which ran from April 1, 2016, through December 31, 2024. The agency said the program saved Medicare $112.7 million while maintaining quality for more than 98,000 knee and hip replacement patients across 323 hospitals in 2021 through 2023. (cms.gov) The proposal would make CJR-X mandatory nationwide, a broader reach than the earlier joint-replacement model and a notable step in CMS’s push toward value-based payment. The Healthcare Financial Management Association said it would be the first value-based payment model set to become mandatory for almost all hospitals nationwide. (cms.gov) (hfma.org) CMS has been building toward that shift with other episode-based models, including the Transforming Episode Accountability Model, or TEAM, which began January 1, 2026. CMS said lessons from CJR informed TEAM, another mandatory model built around surgical episodes and recovery. (cms.gov 1) (cms.gov 2) Hospitals are weighing the proposal alongside a separate payment update in the same rule. CMS projected a 2.4% inpatient payment increase, or about $1.4 billion, for fiscal 2027, while hospital advocates told HFMA the update does not offset inflation, uncompensated care, and uninsured-patient pressures. (cms.gov) (hfma.org) The joint-replacement proposal now enters the comment phase, with comments due June 9, 2026, before CMS decides whether to finalize it. If the rule goes through, hospitals will have about 16 months to prepare for a model that ties orthopedic surgery payments more tightly to what happens after patients leave the operating room. (federalregister.gov) (hallrender.com)
