CMS’s decision to make the Comprehensive Joint Replacement Extended Model mandatory starting in 2028 is drawing cautious optimism about value-based care’s potential alongside concerns about consolidation and who the model will reward.
The federal mandate will reshape how joint replacement care is reimbursed across every U.S. hospital — and orthopedic surgeons warn it could limit patient access to physical therapy and post-acute care while giving large, vertically integrated health systems a structural edge over smaller and rural providers.
These two surgeons connected with Becker’s to share their thoughts on the model.
Note: Responses were lightly edited for clarity and length.
Question: CMS recently finalized that the CJR-X model for joint replacements will become mandatory nationwide in January 2028, expanding what was a pilot into every hospital. What’s your reaction to CMS making this permanent and universal rather than voluntary?
Eric Cohen, MD. Orthopedic Surgeon of University Orthopedics (East Providence, R.I.): The CJR-X model for joint replacement changes how joint replacements are paid within the hospital setting. Sweeping changes and mandates to Medicare payments without going through the channels of Congress will trigger risky consequences for hospitals, surgeons and most importantly, patients. Hospitals will be financially incentivized to monitor and potentially limit post-acute care utilization and physical therapy, two large drivers of spending in the total joint episode. Large health systems that are vertically integrated will certainly have the advantage. Furthermore, smaller hospitals and practices serving more rural communities will face further consolidation and be swallowed up by larger systems to help absorb the financial risk. Monopolies within healthcare limit patient choice and access to surgery and post-operative care.
Emeka Nwodim, MD. Orthopedic Spine Surgeon and Managing Partner of Centers for Advanced Orthopaedics, Bay Area Orthopaedics & Sports Medicine Division (Hanover, Md.): CMS’s implementation of the Comprehensive Joint Replacement Extended Model signals a continued national transition toward bundled payment models and reinforces the broader movement toward value-based care.
If designed and implemented with honesty, integrity, transparency and meaningful stakeholder collaboration, CJR-X and similar payment models have the potential to fundamentally transform healthcare. By aligning financial incentives with quality outcomes, these models can help control costs, improve care coordination, enhance patient outcomes, increase healthcare affordability for the average person and ultimately improve quality of life for patients across the country.
However, the long-term success of any value-based payment model depends on appropriately recognizing, protecting and rewarding the professionals who deliver patient care every day. Physicians, surgeons, nurses, physician assistants, technicians, medical assistants, therapists and administrative staff are the backbone of our healthcare system. These individuals bear the greatest responsibility for delivering safe, high-quality care.
Sustainable payment reform must ensure that those who shoulder the greatest clinical and operational responsibilities are adequately supported, fairly compensated and empowered.
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