Comprehensive Care for Joint Replacement (CJR): Updated Information for Providers

The Comprehensive Care for Joint Replacement (CJR) Model, introduced by the Centers for Medicare & Medicaid Services (CMS) in 2016, shifted hospital reimbursement for hip and knee replacements toward episode-based payment. Originally scheduled to end in 2020, the model was extended through December 31, 2024, with updates designed to improve coordination and outcomes for Medicare beneficiaries¹.

For therapy providers, rehabilitation professionals, and hospital teams working with joint replacement patients, CJR remains an important model to understand. It also provides a foundation for preparing for new models such as the TEAM Model CMS.

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What Is the CJR Model?

The CJR Model holds hospitals responsible for the cost and quality of care for Medicare beneficiaries undergoing lower extremity joint replacement (LEJR) procedures. An episode begins with hospital admission and extends through 90 days post-discharge.

Participation is mandatory for hospitals located in selected Metropolitan Statistical Areas (MSAs) unless they meet exemption criteria, such as low procedure volume or other program eligibility¹.

Under CJR:

• Hospitals continue billing Medicare fee-for-service during care delivery.

• After each performance year, CMS compares the total cost of an episode against a target price.

• Hospitals that deliver care under the target price, while meeting quality standards, may earn a reconciliation payment.

• Hospitals with higher costs or lower quality scores may owe repayments to CMS.

The model encourages providers across care settings to align their efforts and focus on outcomes that matter to patients.

Key Strategies for Success Under CJR

Hospitals bear direct financial responsibility under CJR, but post-acute and rehabilitation providers influence overall results in meaningful ways.

Here are three strategies aligned with current CMS guidelines¹:

1. Strengthen Care Coordination Across Settings

Patients undergoing joint replacement may transition through multiple sites of care, including skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), home health agencies (HHAs), and outpatient therapy.

Strategies to support care transitions:

• Develop shared care plans across inpatient and post-acute providers.

• Standardize communication between discharge planners and therapy teams.

• Focus on early discharge planning and preparing patients for the next level of care.

2. Focus on Care That Supports Recovery Goals

CMS measures hospital performance based on both episode costs and quality outcomes. Functional recovery is a primary goal for joint replacement patients¹.

Strategies to support patient recovery:

• Implement rehabilitation protocols grounded in evidence.

• Document therapy progress using standardized functional outcome tools, such as HOOS, Jr. and KOOS, Jr.

• Coordinate with discharge planners and case managers to match therapy intensity to patient needs.

3. Support Patient Engagement Throughout Recovery

Patients who are active participants in their recovery are more likely to achieve mobility milestones, reduce complications, and avoid rehospitalizations.

Strategies to promote patient involvement:

• Provide clear education on pre-surgical preparation ("prehab") and post-surgical expectations.

• Offer resources that help patients stay connected to therapy programs after discharge.

• Incorporate home exercise programs and digital tools to reinforce therapy goals between visits.

Why CJR Still Matters—and How It Connects to the Future

The CJR Model is part of CMS’s longer-term strategy to move healthcare payment toward outcomes and total cost management¹. Hospitals and therapy providers with experience under CJR will be better prepared for newer initiatives that focus on care episodes.

CMS has announced the upcoming Transforming Episode Accountability Model (TEAM), set to begin in 2026. TEAM builds on lessons learned from CJR, expanding the bundled payment approach to additional surgical episodes while introducing new requirements for coordination and outcome measurement.

Additionally, providers who participated in earlier voluntary models like the Bundled Payments for Care Improvement (BPCI) and BPCI Advanced (BPCI-A) have gained valuable experience in managing episode-based care. These models have laid the groundwork for current and future bundled payment initiatives.​

How Medbridge Supports Providers in Bundled Payment Models

Organizations working to strengthen their performance under CJR and future models can use Medbridge solutions to support patients across the full course of care:

• Home Exercise Program (HEP): Provide consistent, customized exercise programs that patients can complete independently.

• Patient Education Videos: Help patients better understand each phase of recovery and what to expect during therapy.

• Outcome Reporting: Track progress across rehabilitation milestones and align care delivery with functional recovery goals.

References

¹ CMS. (2024). Comprehensive Care for Joint Replacement (CJR) Model