Medicare Payment Policy

CMS is moving Medicare payment policy further toward mandatory value-based models, finalizing the nationwide CJR-X joint replacement bundle to begin in 2028 and giving hospitals roughly 17 months to prepare for episode-based accountability across orthopedic care (HFMA). At the same time, the CY 2027 Physician Fee Schedule’s MSSP provisions signal continued pressure on ACO infrastructure, benchmarking, and participation strategy, while major DOJ settlements involving Medicare Advantage risk-coding allegations underscore a parallel enforcement push against revenue models that rely on diagnosis inflation rather than measurable care management value (Healthcare Dive). For health systems, ACOs, and MA-aligned provider groups, the strategic center of gravity is shifting from voluntary upside opportunities to CMS-directed mandatory bundles, tighter MSSP economics, and higher scrutiny of coding-driven VBC returns.