Bundled Payments

CMS is moving bundled payments back toward mandatory, episode-based accountability in musculoskeletal care, with CJR-X positioned as an expansion/refresh of the Comprehensive Care for Joint Replacement model and stakeholders framing it alongside TEAM, ACCESS, LEAD, ASM, and RISE as a broader Medicare push to reshape orthopedic episodes around cost, quality, site-of-care, and post-acute utilization. The key VBC tension is operational: hospitals, ASCs, surgeons, SNFs, and conveners are being pushed to manage total-joint episodes more tightly, while concerns persist around SNF access, inpatient-vs-outpatient status, and whether mandatory bundles will create savings without constraining appropriate rehab after surgery. See AAPC on CMS’s joint replacement expansion and RAC Monitor on SNF rehab access and CJR’s return.