CJR-X Boosts Affordability of Hip, Knee, and Ankle Replacements
What’s new: CMS has proposed a nationwide expansion of the Comprehensive Care for Joint Replacement (CJR) Model to support an effective and positive recovery experience for people with Original Medicare undergoing hip, knee, and ankle replacements.
Why it matters: The CJR-X (Comprehensive Care for Joint Replacement Expanded) Model would be the first nationwide mandatory episode-based payment model in Original Medicare, scaling the impacts of the CJR Model which ended on December 31, 2024; the most recent evaluation of performance years 6 and 7 (2021-2023) showed that the CJR Model generated an estimated $112.7 million in net Medicare savings while maintaining quality for over 98,000 knee and hip replacement patients across 323 hospitals.
What to expect: CJR-X would be finalized in the Fiscal Year (FY) 2027 Hospital Inpatient Prospective Payment Systems (IPPS) Final Rule, and performance would begin on October 1, 2028 with more than 2,500 participating hospitals anticipated.
The big picture: Episode-based models like CJR-X improve affordability of health care by aligning financial incentives with health outcomes, producing cost savings through more efficient use of services and providing necessary support that empowers people to achieve their health goals.
Additional details: CMS would expand its test of the CJR Model to assess participating acute care hospitals against a target price that assumes all costs associated with a 90-day episode of care, including the inpatient hospitalization or outpatient procedure and nearly all related items and services following discharge, such as physical therapy and follow-up visits. By holding participating hospitals responsible for care and spending in the period following lower extremity joint replacements, the CJR-X Model would encourage hospitals to:
- Work as a team with physicians and post-acute care providers to support patients and ensure optimal outcomes;
- Coordinate care across settings, especially care transitions, from the initial hospitalization or outpatient procedure through recovery; and
- Produce high value care by reducing unnecessary or duplicative services, such as avoidable hospital readmissions.
Find out more:
|
