Half of CJR-X Savings Is a Check You Write
CMS made joint replacement bundles mandatory and national on Friday, starting January 1, 2028. The rule projects $736 million in Medicare savings across five years. Its own table shows participants repaying $1.855 billion and collecting $1.463 billion back, and the sensitivity analysis books savings even if nobody changes anything.
CMS filed the FY 2027 inpatient final rule at 4:15pm on Friday, and buried at section X.C is the return of a model the agency retired nineteen months ago.
Comprehensive Care for Joint Replacement ran from April 1, 2016 through December 31, 2024, mandatory but confined to selected metropolitan areas. The seventh evaluation report found it saved Medicare $112.7 million across two performance years without hurting quality.
That was enough. Under section 1115A(c), the Secretary determined and the CMS Chief Actuary certified, and CJR is coming back as CJR-X: mandatory, national, U.S. Territories included.
Every acute care hospital paid under both the IPPS and the OPPS is in, except TEAM participants and hospitals in Maryland. There is no application, no opt-out, and no end date in the rule.
The agency also priced it. Over five performance years, CMS projects it will pay participants $1.463 billion and that participants will repay $1.855 billion.
Net savings: $736 million.
"How much of a bundled payment model's savings comes from care actually getting cheaper?"
Less than you'd hope.
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