Medicare beneficiaries undergoing knee, hip, and ankle replacements could soon experience more coordinated care and lower costs under a new Centers for Medicare and Medicaid Services (CMS) proposal that seeks to make care more seamless from the hospital to the post-acute care (PAC) setting.

CMS said it is looking to implement these improvements by expanding the Comprehensive Care for Joint Replacement (CJR) Model nationwide through the Fiscal Year (FY) 2027 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) proposed rule.

From April 2016 through December 2024, the CMS Innovation Center tested the model CJR Model to improve care for Medicare patients undergoing joint replacement procedures. During that time, the model generated significant Medicare savings while maintaining quality of care for beneficiaries. Under the CJR Model, hospitals were held responsible for Medicare spending for the joint replacement surgery, the hospital stay, and the first 90 days of recovery, including follow-up care such as physical therapy.

Based on evaluation of the CJR Model, the CJR Expanded (CJR-X) Model would create strong incentives for hospitals to coordinate care more effectively, avoid unnecessary services like avoidable re-hospitalization and emergency care, and focus on delivering the best outcomes for patients. It would specifically encourage better communication with post-acute care providers to support recovery, CMS said.

Mandatory Program

Beginning Oct. 1, 2027, CJR-X would be required for most hospitals, making it the first mandatory, nationwide test of an episode-based payment model, the agency noted.

“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,” said CMS Innovation Center Director Abe Sutton.

Medicare beneficiaries would benefit from earlier communication and planning, and smoother transitions between care settings. They would continue to choose their doctors and receive the care they need without disruption or added complexity.

Models previously expanded nationwide include the Medicare Diabetes Prevention Program, the Pioneer ACO Model, the Home Health Value-Based Purchasing Model, and Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport.

To learn more about the CJR-X Model, including independent evaluation reports, visit: https://www.cms.gov/priorities/innovation/innovation-models/cjr-x

For FY 2027, CMS is proposing that the payment rate for inpatient and long-term care hospitals under this rule would increase by 2.4 percent. These updates reflect the latest available data on hospital costs, CMS said.

The FY 2027 IPPS and LTCH PPS proposed rule can viewed on the Federal Register at: https://www.federalregister.gov/public-inspection/current.

For a fact sheet on FY 2027 IPPS and LTCH PPS proposed rule, visit: https://www.cms.gov/newsroom/fact-sheets/fy-2027-hospital-inpatient-prospective-payment-system-ipps-long-term-care-hospital-prospective.

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