CMS Announces Nationwide Expansion of Proven Joint Replacement Program
The Centers for Medicare & Medicaid Services (CMS) is expanding an initiative to improve care coordination for hip, knee, and ankle replacements, ensuring providers work together from pre-surgery education through post-op recovery to promote a seamless patient care experience and optimal health outcomes.
Beginning in January 2028, most hospitals will be required to participate in the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, which is part of the FY 2027 Inpatient and Long-Term Care Hospital Prospective Payment System Final Rule released today.
“Knee, hip, and ankle replacements are important for helping seniors preserve their mobility and overall well-being,” said CMS Administrator Dr. Mehmet Oz. “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.”
The CJR-X Model will be the first expanded mandatory test of an episode-based payment model. Hospitals will be accountable for Medicare expenditures related to joint replacement surgery, hospitalization, and the initial 90 days of recovery following hospital discharge, including follow-up treatments like physical therapy. Episode-based payments motivate hospitals, surgeons, and post-acute providers to collaborate to help patients recover while reducing avoidable hospitalizations, complications, and unnecessary costs for Medicare and taxpayers.
The CMS Innovation Center tested CJR-X’s predecessor, the Comprehensive Care for Joint Replacement (CJR) Model, from April 2016 through December 2024 to similarly improve care for Medicare patients undergoing joint replacement procedures. The model saved Medicare more than $100 million while maintaining quality of care for patients.
“We look forward to building on the success of the CJR model. CJR-X gives more patients the opportunity for a better care experience when undergoing joint replacement surgery, because hospitals are given the right financial incentives to enhance care coordination, reduce unnecessary services, such as preventable readmissions and emergency visits, and prioritize patient outcomes with post-acute care providers supporting recovery,” said CMS Innovation Center Director Abe Sutton.
Under the CJR-X Model, patients across the country will still choose their own doctors and will not face added complexity in how they receive care. While most hospitals paid under the Inpatient Prospective Payment System (IPPS) will be required to participate in CJR-X, certain hospitals may be exempt, including those participating in the Transforming Episode Accountability Model, those located in Maryland, and those not paid under both the IPPS and Outpatient Prospective Payment System.
Additionally, for FY 2027, CMS, through the IPPS rule, has finalized the payment rate for inpatient and long-term care hospitals (LTCHs) under this final rule to increase by 2.3%, reflecting more recent available data on hospital costs.
For additional information about the finalized payment policies and the Quality Reporting Program changes in the FY 2027 IPPS and LTCH PPS final rule, visit: https://www.cms.gov/newsroom/fact-sheets/fy-2027-hospital-inpatient-prospective-payment-system-long-term-care-hospital-prospective-payment
To learn more about the CJR-X Model, visit: https://www.cms.gov/priorities/innovation/innovation-models/cjr-x
CMS is partnering with the Office of the National Coordinator for Health Information Technology (ONC) to finalize a series of health information technology (health IT) standards and specifications. Learn more at https://healthit.gov/resources/onc-finalizes-the-adoption-of-certain-health-it-standards-in-the-fy2027-cms-ipps-final-rule/
The FY 2027 IPPS and LTCH PPS final rule (CMS-1849-F) can be viewed on the Federal Register at: https://www.federalregister.gov/d/2026-15833.
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