Medicare Will Expand Joint Replacement Payment Model
Hospitals nationwide will soon be accountable for the quality and cost of hip, knee, and ankle replacement recoveries.
Updated on Oct. 6, 2026 in Arthritis
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Beginning January 1, 2028, the Centers for Medicare and Medicaid Services (CMS) will launch the Comprehensive Care for Joint Replacement Expanded (CJR-X) model. The program mandates that most U.S. hospitals accept accountability for costs and care quality throughout the surgery and 90-day recovery period.
Why it matters
This policy aims to incentivize better care coordination for patients undergoing joint replacement procedures while safeguarding taxpayer resources. By aligning financial accountability with clinical outcomes, CMS hopes to reduce unnecessary services across the recovery timeline.
The CJR-X model mandates a 90-day episode-based payment structure for hospitals performing hip, knee, and ankle replacements. It is currently unclear how specific patient outcomes will be weighted in final accountability calculations.
The players
Centers for Medicare and Medicaid Services
The federal agency overseeing health insurance programs for elderly and disabled Americans, which sets payment policies for hospitals.
The details
The program functions by placing hospitals in charge of the financial and clinical performance of the entire surgical episode, including the procedure and the subsequent 90 days of recovery. By bundling these costs, the model encourages hospitals to coordinate more closely with rehabilitation and outpatient facilities. This structure is intended to discourage fragmented care and redundant testing, pushing providers to focus on efficient, high-quality patient recovery.
Timeline
Fiscal Year 2027: The expansion rule was established via the final payment system rule.
January 1, 2028: The CJR-X program model begins nationwide.
Health Landscape
This mandate follows the Fiscal Year 2027 Inpatient and Long-Term Care Hospital Prospective Payment System final rule. It reflects a broader shift in the national healthcare landscape toward value-based care where hospitals are judged by the long-term success of their surgical interventions.
If you are planning a joint replacement, this policy shift may encourage your hospital to offer more streamlined follow-up care and rehabilitation support. It is worth discussing with your doctor how your hospital coordinates your post-operative recovery plan and what resources are available to you.
The takeaway
The move toward bundled payments for joint replacement suggests that hospital-led coordination will play a larger role in how you recover from surgery. Always ask your surgical team what happens after you leave the hospital and who will be managing your care during your 90-day recovery window.
Further reading
For more information on managing your care, visit the Arthritis section.
Source note: This article includes information reported by Healio.
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