--- title: Your Hospital Will Be Accountable for Your First 90 Days After Joint Replacement description: From January 2028 most US hospitals must take part in CJR-X, covering the surgery and the first 90 days of recovery. What it changes for patients. author: Darie Nani (Editor-in-Chief) updated: 2026-08-01T03:24:18.270Z canonical: https://richhealthmagazine.com/article/medicare-cjr-x-90-day-joint-replacement-episode image: https://cdn.nanimediahouse.com/medicare-cjrx-90-day-episode-79702.webp categories: Everyday Wellness content_type: News region: United States publication: Rich Health Magazine schema_type: Article --- If you are on Medicare and facing a hip, knee or ankle replacement, the hospital that performs it will soon carry responsibility for what the next three months cost. Starting in January 2028, most hospitals must take part in a Medicare program that holds them accountable for spending on the surgery, the hospital stay and the first 90 days of recovery after discharge, including follow-up visits and physical therapy. The program is the Comprehensive Care for Joint Replacement Expanded Model, or CJR-X. The Centers for Medicare and Medicaid Services finalized it on July 31, 2026 as part of the annual payment rule for inpatient and long-term care hospitals, and calls it [the first nationwide test of a mandatory episode-based payment model](https://www.cms.gov/priorities/innovation/innovation-models/cjr-x). ## Your choice of doctor does not change CMS has been explicit about the point most patients will ask about first. Under CJR-X, the agency says, patients across the country will still choose their own doctors and will not face added complexity in how they receive care. What changes is the way the hospital is paid. ## Medicare will measure the whole recovery against one target Under Original Medicare's fee-for-service system, the surgeon, the hospital and the providers who handle recovery are each paid separately for what they do. CMS says that separation can lead to fragmented care, duplicated use of resources and avoidable treatment, leaving patients feeling unsupported and at greater risk of complications after surgery. CJR-X groups all of it into a single episode. The episode begins with the procedure and ends 90 days after discharge from the hospital stay or the outpatient procedure. With few exceptions it takes in every related item and service paid under Medicare Part A and Part B: the procedure itself, the hospital stay, physical therapy after discharge, and follow-up visits. Everyone treating the patient continues to be paid as they are today. After each performance year, CMS compares what the episode actually cost against a target price set for the hospital. Depending on how that hospital performed on spending and on quality, it can receive an additional payment from Medicare or be required to repay part of the episode spending. ## Quality has to clear a bar before a hospital is paid more A hospital cannot earn an additional payment simply by spending less. CMS applies what it calls a quality-first principle: a hospital has to reach a minimum level of episode quality, measured by a composite score, before it receives any reconciliation payment. That score draws on five measures: the risk-standardized complication rate after elective hip and knee replacement, hospital visits within seven days of outpatient surgery, the HCAHPS patient survey, the outpatient and ambulatory surgery patient survey, and a patient-reported outcome measure for hip and knee replacement. ## Not every hospital has to join [Most hospitals paid under the Inpatient Prospective Payment System will be required to take part](https://www.cms.gov/newsroom/press-releases/cms-news-cms-announces-nationwide-expansion-proven-joint-replacement-program). Some are exempt, including hospitals already in the Transforming Episode Accountability Model, hospitals in Maryland, and hospitals not paid under both the Inpatient and Outpatient Prospective Payment Systems. TEAM and CJR-X are separate programs and are easy to confuse. TEAM also covers procedures other than joint replacement, among them heart surgery and spinal fusion, and its episode runs 30 days rather than 90. Hospitals in TEAM are excluded from CJR-X, and when TEAM ends they would be required to join it. ## Rural and safety net hospitals carry less of the risk CJR-X applies a 5 percent stop loss to hospitals serving a high proportion of patients eligible for both Medicare and Medicaid, to hospitals that are geographically rural without meeting the statutory definition of a rural hospital, to Medicare-dependent small rural hospitals and to Sole Community Hospitals. The model also uses 29 risk adjusters where the earlier version used three. At the level of the individual episode it accounts for age, the number of chronic conditions a patient has, whether they are eligible for both Medicare and Medicaid, the type of procedure, whether disability was the original reason for Medicare enrollment, prior use of post-acute care, and 21 specific condition categories. CMS says the approach better reflects how sick a patient is, so that hospitals are not penalized for treating people who are complex or whose care becomes unpredictably complicated. ## The earlier version ran for eight years in 34 metropolitan areas CJR-X expands a program Medicare has already run. The Comprehensive Care for Joint Replacement Model operated from April 2016 to December 2024. Its most recent evaluation, covering performance years six and seven from 2021 to 2023, estimated $112.7 million in net savings while quality of care held up. Abe Sutton, who directs the CMS Innovation Center, said CJR-X “gives more patients the opportunity for a better care experience when undergoing joint replacement surgery, because hospitals are given the right financial incentives to enhance care coordination, reduce unnecessary services, such as preventable readmissions and emergency visits, and prioritize patient outcomes with post-acute care providers supporting recovery.” > "Knee, hip, and ankle replacements are important for helping seniors preserve their mobility and overall well-being." > — Dr. Mehmet Oz, CMS Administrator ## FAQ **Q: When does CJR-X start?** January 2028. It was finalized on July 31, 2026 as part of Medicare's annual payment rule for inpatient and long-term care hospitals. **Q: Does CJR-X change which doctor I can see?** No. CMS says patients across the country will still choose their own doctors and will not face added complexity in how they receive care. What changes is how the hospital is paid. **Q: Which surgeries does CJR-X cover?** Hip, knee and ankle replacements, including hip replacement where the main diagnosis is a hip fracture. **Q: How is CJR-X different from TEAM?** The Transforming Episode Accountability Model covers procedures beyond joint replacement, including heart surgery and spinal fusion, and its episode runs 30 days against 90 days for CJR-X. Hospitals taking part in TEAM are excluded from CJR-X. **Q: Will every hospital take part?** Most hospitals paid under the Inpatient Prospective Payment System will be required to. Hospitals already in TEAM, hospitals in Maryland, and hospitals not paid under both the Inpatient and Outpatient Prospective Payment Systems may be exempt.