CMS expands joint replacement program nationwide to improve patient care

The Centers for Medicare & Medicaid Services (CMS) has announced the nationwide expansion of a program designed to enhance the quality and coordination of care for individuals undergoing joint replacement surgeries. Beginning in January 2028, most hospitals will be required to participate in the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model [CMS Newsroom].

A focus on coordinated care

This expanded initiative targets hip, knee, and ankle replacements. The goal is to ensure that healthcare providers work together throughout the patient's surgical journey, from initial education before surgery to recovery after the operation. This integrated approach is expected to lead to a more seamless experience for patients and better health outcomes [CMS Newsroom].

Part of broader payment system changes

The expansion of the CJR-X Model is included in the recently released FY 2027 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final Rule (CMS-1849-F) [CMS Newsroom]. These annual rules set payment rates and policies for inpatient services provided by hospitals and long-term care hospitals participating in Medicare. The inclusion of the CJR-X Model in this rule underscores CMS's commitment to value-based care, where providers are incentivized to deliver high-quality, coordinated care rather than simply a high volume of services.

Impact on patients and hospitals

For patients considering or undergoing joint replacement surgery, this expansion means that more hospitals will be adopting a standardized approach to care, which could reduce variability in quality and improve the overall patient experience. By requiring most hospitals to participate, CMS aims to ensure that these benefits are widely available across the country.

Hospitals, in turn, will need to adapt their care delivery models to meet the requirements of the CJR-X Model. This typically involves establishing clear communication pathways between different providers, implementing robust patient education programs, and monitoring patient outcomes more closely to identify areas for improvement. The shift towards bundled payments and coordinated care models is a long-standing trend in Medicare, aiming to improve efficiency and quality while controlling costs [KFF Medicare].