CMS expands mandatory joint replacement model to most hospitals

Clinical takeaway: The existing model has resulted in savings by reducing post-acute facility use without measurably changing complications, and that trend seems likely to hold in hospitals new to the model.

A Medicare pilot that ran for nearly nine years in a few dozen metro areas is returning as a national requirement. CMS finalized the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model on July 31, making most hospitals it pays for inpatient care responsible for the full cost of a joint replacement and the recovery that follows.

It is the first time the agency has made joint replacement bundles the default rather than a regional test. Under an episode-based payment model, a hospital answers for the total cost of a procedure and everything related to it for a fixed window afterward.

Hospitals will be accountable for Medicare spending across a single episode: the hip, knee, or ankle replacement, the hospital care surrounding it, and the first 90 days after discharge, including physical therapy and any related return to the hospital. CMS attributes more than $100 million in net savings to the original model, which ran between April 2016 and December 2024, with quality holding.

Hospitals, surgeons, and post-acute providers keep submitting claims as usual, and CMS settles up afterward: total spending on the episode gets measured against a target price, with the hospital keeping a share if it comes in under and repaying Medicare if it runs over. Quality scores determine whether a hospital is eligible for savings at all. The hospital carries that risk alone, including for care delivered by clinicians it does not employ.

The January 2028 implementation deadline gives hospitals about 18 months to build what the model rewards: education before surgery, discharge planning that starts before admission, and follow-up structured to catch problems early. Those pathways tend to be designed inside the hospital and extended outward, which means clinicians in referring practices often meet the new arrangement through a returning patient.

CMS is exempting facilities already participating in the Transforming Episode Accountability Model, a separate mandatory bundle that began in January 2026 and covers joint replacement among other procedures, along with hospitals in Maryland and those outside both the inpatient and outpatient payment systems.

"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," said Abe Sutton, director of the CMS Innovation Center.

Source: CMS. (2026 Jul 31). CMS Announces Nationwide Expansion of Proven Joint Replacement Program