Medicare Will Require Most Hospitals to Join a Mandatory Joint Replacement Care Model Starting in 2028

The Centers for Medicare and Medicaid Services announced on October 6 that it will expand its joint replacement care program into a mandatory nationwide model starting January 1, 2028. The new program, called CJR-X, will require most hospitals paid under the Medicare Inpatient Prospective Payment System to participate.

The announcement came alongside the release of the final evaluation report for the original Comprehensive Care for Joint Replacement program, which found the model generated 180 million dollars in net Medicare savings across its final three performance years, covering October 2021 through December 2024, while maintaining quality of care for patients.

Under CJR-X, hospitals will be financially accountable for all Medicare spending tied to a joint replacement, from the surgery and the hospital stay through the first 90 days of recovery after discharge. That window covers follow-up services such as physical therapy and care in skilled nursing facilities. The design is intended to encourage hospitals, surgeons, and post-acute providers to coordinate more closely throughout a patient's recovery.

The original CJR model operated in a limited group of markets and was voluntary in its later years. CJR-X will be mandatory and broadly applied. CMS has described it as the first mandatory nationwide test of an episode-based payment model in Medicare.

For Medicare beneficiaries scheduled for a hip, knee, or ankle replacement, participation in the model is automatic based on where the procedure takes place. Exceptions apply to hospitals in Maryland, those participating in the Transforming Episode Accountability Model, and facilities not paid under both the inpatient and outpatient prospective payment systems.