The Centers for Medicare & Medicaid Services (CMS) is proposing a major expansion of its bundled payment approach for hip, knee, and ankle replacements through the FY 2027 Hospital Inpatient Prospective Payment System rule. The move would scale the Comprehensive Care for Joint Replacement (CJR) initiative into a nationwide model designed to improve coordination and reduce total episode costs for Medicare beneficiaries.
Under the proposed CJR Expanded (CJR-X) Model, hospitals would be financially accountable for the full episode of care—covering the surgery, hospitalization, and 90-day recovery period, including post-acute services such as rehabilitation. CMS says the goal is to strengthen coordination between hospitals and post-acute providers, reduce avoidable readmissions, and improve recovery outcomes.
The model builds on results from the original CJR program, which was tested from 2016 through 2024 by the CMS Innovation Center. CMS reports that the pilot generated savings while maintaining quality of care for Medicare patients undergoing joint replacement procedures.
If finalized, CJR-X would become the first mandatory, nationwide episode-based payment model for most hospitals beginning October 1, 2027. CMS officials say the approach is intended to streamline patient experience by improving communication across care settings and reducing the need for patients to navigate complex transitions during recovery.
The proposal also includes refinements based on prior model performance and stakeholder feedback, continuing CMS’s broader shift toward value-based reimbursement structures that tie payments more directly to outcomes and total cost of care.
Resource: CMS to Improve Patient Care Experience and Lower Costs for Hip, Knee, and Ankle Replacements