WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) wants to expand a pilot program that makes hospitals responsible for Medicare spending for post-acute recovery for hip and knee replacements.
CMS announced it is looking to expand the Comprehensive Care for Joint Replacement (CJR) Model nationwide through the fiscal year 2027 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) proposed rule.
“Every year, Medicare funds thousands of knee, hip and ankle replacements that help seniors keep up with their speedy little grandkids,” said CMS Administrator Dr. Mehmet Oz. “This proposed expansion of our successful joint replacement pilot program would better align financial incentives with improved health outcomes—protecting taxpayer dollars while ensuring patients get the care they need before, during and after surgery.”
From April 2016 through December 2024, the CMS Innovation Center tested the CJR Model with the goal of improving care for Medicare patients undergoing joint replacement procedures. During that time, CMS said the model generated Medicare savings while maintaining quality of care for beneficiaries. Under the CJR Model, hospitals were held responsible for Medicare spending for the joint replacement surgery, the hospital stay and the first 90 days of recovery, including follow-up care such as physical therapy.
Based on evaluation of the CJR Model, CMS said the CJR Expanded (CJR-X) Model would create strong incentives for hospitals to coordinate care more effectively, avoid unnecessary services like avoidable re-hospitalization and emergency care, and focus on delivering the best outcomes for patients. Beginning Oct. 1, 2027, CJR-X would be required for most hospitals, making it the first mandatory, nationwide test of an episode-based payment model.
“Patients would have a more seamless, better care experience through the CJR-X Model, allowing them to focus on recovery instead of acting as the go-between for their own care,” said CMS Innovation Center Director Abe Sutton.
As part of expansion, CMS said it would implement certain refinements based on experience and stakeholder feedback, including updates to payment policies.