A proposed CMS rule could change how almost every acute care hospital in the US is paid for hip and knee replacement surgery. If finalized, CJR-X arrives in October 2027 and most hospitals are not yet prepared.
Why This Matters
If your hospital performs hip or knee replacement surgery, a significant change to how you are paid for those procedures could be coming as soon as October 2027.
The Comprehensive Care for Joint Replacement eXpanded, known as CJR-X, is a proposed mandatory bundled payment program for lower extremity joint replacements. If the proposed rule is finalized, it will apply to almost every acute care hospital in the United States. Unlike the TEAM model, which covers a range of surgical procedures across a defined set of participating hospitals, CJR-X is designed to be nationwide and covers a 90-day episode of care, three times longer than TEAM.
For nursing leaders, that 90-day window matters. It means a patient’s full recovery, including any complications that develop at home, in rehabilitation, or during follow-up care, falls within your hospital’s financial accountability. A pressure injury that develops during or after a joint replacement admission does not just affect that patient’s experience. It affects your hospital’s cost performance across the entire episode.
The direction of travel is clear. Bundled payments for joint replacements are becoming the permanent standard, and hospitals that understand the model early will be better positioned when it arrives.
What It Actually Is
CJR-X is a payment model where CMS sets a target cost for the complete care of a patient having a hip or knee replacement. That target covers everything Medicare pays for from the moment of admission through to 90 days after discharge: the surgery itself, the hospital stay, rehabilitation, outpatient care, home health, wound care, and follow-up appointments.
At the end of a performance period, CMS compares what was spent on all qualifying patients against the target. Costs that come in below the target earn your hospital an additional payment. Costs that exceed the target result in a payment owed to CMS.
Quality also plays a role. CMS adjusts the reconciliation based on your hospital’s performance on specific quality measures, which means clinical outcomes have a direct bearing on financial results. The program applies to both inpatient hip and knee procedures and their outpatient equivalents, making it relevant for a broad range of surgical programs.
Hospitals already participating in TEAM are exempt from CJR-X until 2030. For all other acute care hospitals, October 2027 is the current proposed start date, assuming the rule is finalized as proposed.
Watch the video below for a full breakdown of CJR-X, how it compares to TEAM, and what your hospital should be considering now.
To talk to Bruin Biometrics about how we can support your team with pressure injury prevention, documentation, and preparation for bundled payment programs, contact us at info@bruinbiometrics.com to learn how we can support your team.