Joint Replacement Model: It’s All Coming Together

The term “joint” can connote a lot of things. It can be something that’s lit up and smoked; it can refer to a dubious place or disreputable bar; but it most naturally indicates a coming together of two or more components—like a joint meeting of Congress or a plumber’s pipe joints. And, of course, there are anatomical joints in the mix, as well. It is in connection with this last meaning of “joint” that we will devote the balance of today’s alert.

In a follow-up to our series of articles on the 2027 Inpatient Prospective Payment System (IPPS) final rule, it is worth noting that the rule will also expand the Comprehensive Care for Joint Replacement (CJR) model. The CJR model is credited by the Centers for Medicare & Medicaid Services (CMS) with producing cost savings while simultaneously maintaining quality of care. The expanded model, designated as CJR-X (not to be confused with the sporty Honda model of nearly the same name), is designed to improve care for Medicare patients undergoing hip, knee and ankle replacements (also called lower extremity joint replacements) performed in inpatient and hospital outpatient settings. The CJR-X model will be mandatory nationwide and begin on January 1, 2028.

The following summary of the model’s expansion, per the IPPS final rule, is based on a July 31 press release by CMS, which begins as follows:

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.

Again, beginning in January 2028, most hospitals will be required to participate in the CJR-X model. According to CMS Administrator Dr. Mehmet Oz:

Knee, hip and ankle replacements are important for helping seniors preserve their mobility and overall well-being. 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 has the distinction of being 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—to include follow-up treatments, like physical therapy. CMS believes that episode-based payments will 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. CMS claims the model saved Medicare more than $100 million while maintaining quality of care for patients.

The following statement was released by CMS Innovation Center Director Abe Sutton:

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.

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 IPPS will be required to participate in CJR-X, certain hospitals may be exempt—including (a) those participating in the Transforming Episode Accountability Model, (b) those located in Maryland, and (c) those not paid under both the IPPS and Outpatient Prospective Payment System.

So, it all appears to be coming together for those Medicare patients who need two bones to work together, without pain and impairment. The government’s new expanded model appears to be an attempt to improve on that process.

To learn more about the CJR-X model, you can click on the following link: https://www.cms.gov/priorities/innovation/innovation-models/cjr-x.