Prepare for CJR-X before the first performance year begins
CJR-X is mandatory for most hospitals from January 1, 2028, with two-sided risk from year one. We show where you stand against your region now.
- Who
- Acute care hospitals paid under both the IPPS and OPPS. Excludes TEAM participants and Maryland.
- Episodes
- Hip, knee, and ankle replacement. MS-DRGs 469, 470, 521, 522 and HCPCS 27130, 27447.
- Risk
- Losses capped at 20% of target, or 5% for safety net, rural, and certain other hospitals.
What makes CJR-X hard
How CJR-X works
- 1Care is billed as usualProviders bill Medicare through the 90-day episode.
- 2CMS sets a regional targetCensus division spending, risk adjusted, less 2%.
- 3CMS reconciles yearlySpending is compared to target from year one.
- 4Quality comes firstMeet the minimum quality score to earn a payment.
Risk limits
Gains and losses are capped as a share of target spending. Two-sided risk applies from the first year.
Quality comes first
A hospital must reach a minimum composite quality score to earn any payment. Stronger quality lowers the discount CMS applies.
What’s ahead
- End 2026Participant list expected
- Jul 2027Risk lookback begins
- Jan 2028Year 1, two-sided risk
- 2029First reconciliation
Proven in bundled payments
Economic and Clinical Outcomes Under CMS Mandatory Bundled Payments for Joint Replacements
Our team co-authored this JAMA study of the original CJR model, the mandatory joint replacement bundle that CJR-X now expands nationwide.
Read the study in JAMAResults published in Harvard Business Review
Why the field trusts us
We host the nation’s only bundled payment summit
Sacha Wolf of the CMS Innovation Center, who works on both CJR-X and TEAM, gave her first public talk on CJR-X at our 8th Summit in August 2026.
The only company published in Harvard Business Review on bundled payments
Would you like a PDF copy of an article? Email Derek Haas.
How we help hospitals prepare for CJR-X
Know your CJR-X starting point
Our team will walk through your joint replacement episodes and where your largest opportunities are.