The Centers for Medicare & Medicaid Services (CMS) has expanded the Comprehensive Care for Joint Replacement (CJR) Model, which aims to encourage collaboration among health care entities — including home health providers.
Most hospitals will be required to participate in the CJR Expanded (CJR-X) model beginning in January 2028.
“CJR-X gives more patients the opportunity for a better care experience when undergoing joint replacement surgery, because hospitals are given the right financial incentives to enhance care coordination, reduce unnecessary services, such as preventable readmissions and emergency visits and prioritize patient outcomes with post-acute care providers supporting recovery,” CMS Innovation Center Director Abe Sutton said in a statement.
The CJR-X model is the first expanded mandatory test of an episode-based payment model, which CMS stated helps motivate hospitals, surgeons and post-acute providers to collaborate to help patients recover.
CJR-X participation will be mandatory for most hospitals paid under the Inpatient Prospective Payment System (IPPS). Some hospitals may be exempt from the model, including those participating in the Transforming Episode Accountability Model (TEAM), which makes hospitals accountable for the quality and costs of patients with one of five selected conditions. Hospitals in Maryland and those not paid under both the IPPS and Outpatient Prospective Payment System also may not be exempt.
CMS proposed this expansion to the CJR model in April.
“In the CJR-X Model, participating hospitals would be responsible for ensuring patients receive high-quality, coordinated, affordable care from the time of their procedure through the first 90 days of recovery, which incentivizes hospitals to help patients navigate all aspects of care, including physical therapy and other outpatient or at-home rehabilitation,” CMS stated in its proposal for the CJR expansion.
The original CJR model was in place from April 2016 to December 2024 and saved Medicare over $100 million while maintaining care quality, according to CMS.
The previous model increased home health care utilization for certain hip- and knee-replacement patients and modestly increased the number of joint replacement patients receiving home health care. Overall, it was a “win” for home health providers, Brian Fuller, managing director of ATI Advisory’s value-based care design and delivery practice, previously told Home Health Care News.