WASHINGTON, D.C. — Seniors undergoing knee, hip, and ankle replacements could see more coordinated care and potentially lower costs under a proposed nationwide Medicare payment model expansion.
What This Means for You
- Joint replacement patients may experience more coordinated care during recovery
- Hospitals would be responsible for costs tied to surgery and follow-up care
- Medicare payment rates for hospitals are proposed to rise by 2.4% in 2027
The Centers for Medicare & Medicaid Services, or CMS—the federal agency that oversees Medicare—proposed expanding its Comprehensive Care for Joint Replacement model nationwide as part of a broader hospital payment rule for fiscal year 2027.
The model is an “episode-based payment” system, meaning hospitals are financially responsible not just for the surgery itself, but for all related care during a set period, including recovery and rehabilitation.
How the Model Works
Under the proposal, hospitals would be accountable for the total cost of care for joint replacement patients from the procedure through 90 days after discharge.
This includes the hospital stay, follow-up visits, and services such as physical therapy. The goal is to encourage providers to coordinate care, avoid unnecessary services like preventable readmissions, and focus on patient outcomes.
From 2016 through 2024, CMS tested the model in select areas and reported that it reduced Medicare spending while maintaining care quality.
Proposed Expansion
The expanded version, known as the CJR-X Model, would begin October 1, 2027, and apply to most hospitals nationwide, making it the first mandatory, nationwide test of this type of payment system.
Officials said the model is designed to improve communication between hospitals and post-acute care providers, such as rehabilitation centers, to support smoother recovery for patients.
“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,” CMS Innovation Center Director Abe Sutton said.
Patient Impact
CMS said patients would continue to choose their doctors and receive necessary care without additional administrative steps.
The agency expects earlier care planning and improved coordination between providers to reduce complications and improve recovery outcomes.
Payment Updates and Next Steps
As part of the same proposed rule, CMS said it plans to increase payment rates for inpatient and long-term care hospitals by 2.4% in fiscal year 2027, based on updated cost data.
The proposal is open for public review and comment through the Federal Register.
More information about the joint replacement model is available at https://www.cms.gov/priorities/innovation/innovation-models/cjr-x, and the full proposed rule can be viewed at https://www.federalregister.gov/public-inspection/current.
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