CJR-X to Put 2,217 Hospitals at Risk for Joint Replacement Costs
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Brookfield, Conn. – November 03, 2026 -- Medicare's CJR-X model will place 2,217 hospitals under mandatory two-sided financial risk on January 1, 2028. CMS's final rule projects those hospitals will repay $1.855 billion over five years while receiving $1.463 billion.
The model makes hospitals responsible for the full cost of hip, knee and ankle replacements through 90 days after discharge. Hospitals that beat a regional target price earn a bonus, while those that miss it pay Medicare back.
CMS projects a net $392 million transfer from hospitals to Medicare
The repayment gap leaves a net $392 million flowing to Medicare. More than half of the projected $736 million in savings comes from pricing alone.
Predecessor CJR left 60% of participating hospitals owing money in 2023
The earlier CJR program shows the direction of travel: