Medicare to Require Most Hospitals to Coordinate Joint Replacement Care Starting 2028

Full analysis

Beginning in January 2028, most U.S. hospitals will be required to participate in the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, a new Medicare program that holds hospitals financially accountable for the full episode of care surrounding hip, knee, and ankle replacements — from pre-surgery through the first 90 days of recovery, including physical therapy. Under the model, hospitals, surgeons, and post-acute providers share responsibility for Medicare spending, with the goal of reducing preventable readmissions, complications, and unnecessary costs. Patients keep their choice of doctors and face no added complexity in how they receive care, though certain hospitals are exempt, including those in Maryland and those participating in a separate accountability model.

The program expands on a predecessor model (CJR) that CMS ran from April 2016 through December 2024 and that saved Medicare more than $100 million while maintaining quality of care. The expansion is part of the FY 2027 Inpatient and Long-Term Care Hospital Prospective Payment System Final Rule, which also finalizes a 2.3% payment rate increase for inpatient and long-term care hospitals. For the roughly 1 million Medicare beneficiaries who undergo joint replacements each year, this rule means their hospital will have a stronger financial incentive to manage their recovery carefully after surgery.