CMS expands joint replacement program nationwide to improve patient care

The Centers for Medicare & Medicaid Services (CMS) is significantly expanding a program focused on improving care coordination for individuals undergoing hip, knee, and ankle replacement surgeries [CMS Newsroom]. This initiative, known as the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, seeks to ensure that healthcare providers work together seamlessly, from pre-surgery education through post-operative recovery, to promote better patient care and optimal health outcomes [CMS Newsroom].

Mandatory Participation for Most Hospitals

Starting in January 2028, most hospitals across the country will be required to participate in the CJR-X Model. This mandate is part of the recently released FY 2027 Inpatient and Long-Term Care Hospital Prospective Payment System Final Rule [CMS Newsroom]. The expansion signifies CMS's commitment to standardizing and enhancing the quality of care for these common orthopedic procedures, which are vital for many older adults and people with disabilities to maintain mobility and independence.

A Proven Approach to Coordinated Care

The CJR-X Model is built upon previous successes in coordinating care. It emphasizes a bundled payment approach, where hospitals are held accountable for the quality and cost of an episode of care, from the initial surgery through 90 days post-discharge. This encourages hospitals and other providers, such as physical therapists and home health agencies, to collaborate more effectively to prevent complications, reduce readmissions, and improve recovery [CMS Newsroom]. The goal is to create a more integrated care journey for patients, leading to better results and potentially lowering overall healthcare costs.

Impact on Patients and Providers

For patients, this expansion means a more structured and supportive care experience for joint replacement surgeries. It aims to reduce the burden of navigating multiple providers and services, as care teams are incentivized to communicate and coordinate more efficiently [CMS Newsroom]. For hospitals, while mandatory participation presents new requirements, it also offers an opportunity to refine existing care pathways, embrace best practices, and improve patient satisfaction and outcomes in a high-volume surgical area. This move by CMS underscores the growing focus on value-based care models that prioritize quality and efficiency in healthcare delivery.