3 Quick Takeaways on CJR-X from CMS

The Centers for Medicare and Medicaid Services (CMS) recently announced another mandatory model for hospitals, an expansion of its Comprehensive Care for Joint Replacement (CJR) model. Similar to TEAM, the new CJR-X model centers around episodes of care (also known as bundled payments). It is expansive in its scope, encompassing every hospital not already mandated to participate in TEAM. Here are three quick takeaways that CJR-X participants, payers, and the broader healthcare industry need to understand about this new model.

1: CJR-X Impacts High-Volume Procedures at Every Hospital

CJR-X creates an episode-based payment for a lower extremity joint replacement (LEJR) — which includes hip replacement, knee replacement, and ankle procedures — for Traditional Medicare patients. The model requires all hospitals not already participating in TEAM to meet cost and quality targets for LEJR procedures, encouraging surgeons, care teams, and post-acute care providers to collaborate and work together to ensure optimal outcomes.

LEJR procedures are some of the highest volume procedures in any hospital, with Traditional Medicare patients receiving more than 1.6 million total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgeries combined in 2022, according to a November 2025 article published in The Journal of Arthroplasty. The article projects LEJR volume to grow to nearly 2.8 million procedures per year by 2040, making this a critical target for reducing costs and improving outcomes in any CMS episode-based payment model.

2: The Post-Procedure Window is Longer than TEAM

One of the important aspects of episode-based payment models is the inclusion of a post-acute follow-up window. The episode of care for CJR, and now CJR-X, begins with the procedure (inpatient or outpatient) and ends 90 days after hospital discharge. This is longer than the post-acute treatment window for TEAM, which is only 30 days.

Mandatory CJR-X hospital participants must understand that a longer window offers multiple pathways to hit cost targets by focusing on:

• Reducing the cost of care within the procedure itself through enhanced collaboration, appropriate site of service, and eliminating waste and duplication.

• Reducing the cost of post-acute care and the risk of hospital readmission by coordinating with skilled nursing, home health, therapy, and other providers involved in a patient’s care following hospital discharge.

3: This Signals a Broader Push Toward Bundled Payments

With the introduction of CJR-X, every hospital in the U.S. that serves Traditional Medicare patients will now be part of a mandatory bundled payment model. CJR-X, along with TEAM and the newly released information on the CARA option through LEAD, are clear signals from CMS that episode-based payment models are going to be a cornerstone of U.S. healthcare moving forward. For every hospital, provider organization, and payer — including commercial payers — the key will be to put the infrastructure in place right now to participate and succeed at a high level.

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