CJR-X · EXPLAINERCJR-X · EXPLAINER
Prepared for the AAHKS communityOn August 4, 2026 CMS finalized the Comprehensive Care for Joint Replacement Expanded model. It is mandatory, it is nationwide, and for the first time in the Innovation Center's history it has no end date. Ten screens, no jargon left unexplained. Use the arrows or your keyboard.
Today Medicare pays each provider separately: the hospital, the surgeon, the SNF, the home-health agency, the readmission. Under CJR-X, CMS still pays everyone the usual way, then adds up everything related for 90 days after discharge and compares the total to a target price. Below the target, the hospital receives a reconciliation payment. Above it, the hospital repays Medicare.
There is no hospital-specific blend this time. Your target is the Census-division average for your episode type, built from a three-year baseline weighted 17 / 33 / 50 toward the most recent year, then adjusted for patient and hospital risk, trended forward, normalized, capped for outliers at the 99th percentile, and discounted.
If your episode costs run above your region today, that gap is in your target from day one. Comorbidity documentation inside the 180-day lookback is now target-price construction.
A 2.0% discount builds the preliminary target. At reconciliation CMS re-sets the discount using your Composite Quality Score (0–20), built from five measures: THA/TKA complications (50%), HCAHPS (40%), and the PRO-PM (10%) for inpatient episodes; OP-36 hospital visits, OAS CAHPS, and the PRO-PM for outpatient episodes.
Points are assigned by national percentile on each measure; a missing measure scores at the 50th percentile. On a $30M LEJR book, Acceptable-to-Excellent is roughly $600,000 a year before any savings. The PRO-PM is pay-for-performance from PY1 and is also the Hospital IQR measure whose non-reporting costs a quarter of the market-basket update on all inpatient revenue.
Repayment and reconciliation payment are each capped at 20% of the hospital's aggregated target. Medicare-dependent, rural, safety-net, and sole-community hospitals get a 5% repayment cap; their upside stays at 20%. AHA asked for a five-year phase-in; AAHKS asked for TEAM-style tracks. Both were denied on actuarial-certification grounds.
The safety-net line is a cliff at the 25th percentile. A hospital at the 24th gets neither the risk adjuster nor the 5% cap.
Hip-fracture arthroplasty, hemiarthroplasty included, groups to MS-DRG 521/522 and triggers a full 90-day episode. These are not optimized elective patients; they arrive through the ED with hours, not weeks, of preparation, higher MCC rates, and post-acute trajectories that run through SNFs.
Where does your episode cost sit against your Census-division average, and where does your estimated CQS land? The engine gives a first read for every hospital.
≥50% matched pre/post-op PROMs. It is 10% of the CQS, pay-for-performance from PY1, and an IQR penalty if missed.
The 21 HCC flags and prior-procedure flags are your risk adjustment. Fracture patients especially.
SNF 3-day waiver needs ≥3-star SNFs; nine reimbursable home visits per episode; telehealth codes that outlive the national extensions.
Sharing is voluntary and can pass through 100% of the reconciliation payment. Come with case mix and post-acute referral patterns quantified. No Stark/AKS waivers this time; use the CMS-sponsored-model safe harbor.
Monthly claims feeds, PT- and APP-led virtual touchpoints through the 90 days, and a way to see the post-acute black box before the reconciliation report does.
Every hospital's estimated CQS tier, quality-adjusted discount, corridor, and regional target proxy, from public CMS data.
The section-by-section walkthrough of the final rule, with the comment-letter scorecard, on Techy Surgeon.
AI care navigation and episode analytics for TEAM, CJR-X, and the ACCESS Model, deployed with health systems and PT partners.
Christian Péan MD, MS · orthopedic trauma surgeon · Duke faculty · CEO, RevelAi Health. Every parameter checked against the Federal Register text of CMS-1849-F (91 FR 49570). Educational content; not affiliated with CMS; not endorsed by AAHKS unless stated. Less noise, more signal.
