Two doors out of the workshop

The world is the map. The full section-by-section reading of the rule — every § reference, the comment-period targets, the operator moves — lives behind these doors.

The receipts

Every number in this world comes from the proposed rule, the model page, or the cited literature. Where CMS invited comment, that's flagged in the full analysis.

1. CMS — FY 2027 IPPS Proposed Rule (CMS-1849-P), Section X.C: the CJR-X model. Proposed April 10, 2026; PY1 begins October 1, 2027 (§ 512.630(a)); mandatory for eligible IPPS hospitals nationwide (§ 512.615). Triggers: MS-DRG 469/470/521/522 + HCPCS 27130/27447 (§ 512.610). CMS CJR-X model page
2. Target price: 100% regional benchmark from PY1 (§ 512.640); TEAM's nine-lever risk adjustment (§ 512.645); trend correction capped ±3%; normalization capped ±5%; 2.0% discount (§ 512.605, § 512.640(b)(8)).
3. Composite Quality Score: RSCR, OP-36, HCAHPS, OAS CAHPS, PRO-PM — complications 50%, patient experience 40%, PROs 10% (§ 512.635); Excellent zeroes the discount, Below Acceptable is excluded from reconciliation payments (§ 512.645(h), Table X.C-05).
4. Post-acute care as the margin lever: Haas et al., JAMA Internal Medicine 2019 — CJR savings were driven primarily by reduced SNF utilization; Dundon et al. — coordination cut SNF use from 28.8% to 6.7% and readmissions from 7.4% to 4.1%. Reconciliation corridors ±20% standard / ±5% protected (§ 512.650(c)(6)); post-episode monitoring days 91–120.
5. PROMs: collection mandatory via the HIQR program since July 1, 2025 (PROMIS Global-10, VR-12, HOOS Jr., KOOS Jr.); ≥50% postoperative collection required for full annual payment by 2028; PRO-PM is 10% of CQS but frequently decides the Good-vs-Excellent tier.
6. Outreach and navigation evidence: Phillips et al. — nurse navigation cut 90-day episode costs by $1,575 per Medicare patient; Rosner et al. — automated digital engagement reduced avoidable 90-day costs by $656 per patient with 54% fewer complications; CJR-X waives up to nine ~$50 post-discharge home visits per episode (§ 512.695(c)) against $15,000–25,000 readmissions; telehealth flexibility (§ 512.695(a)).
7. Christian Pean, MD, MBA — Follow the Incentives and The Operator's Guide to CJR-X.