Medicare Payment & Programs

CMS has proposed a mandatory, nationwide episode-based payment model—CJR-X—to expand bundled payments for joint replacements, requiring nearly all hospitals to manage Medicare spending across surgical and post-acute settings, including heightened coordination with home health and skilled nursing providers. In parallel, CMS is advancing its shift toward advanced accountable care, with the LEAD Model introducing fixed-base years, expanded capitation, and specialist risk-sharing, signaling a sustained federal push for greater financial accountability and integration across the care continuum. These accelerated policy moves reflect increasing expectations for provider integration and new risk-bearing structures across Medicare value-based care initiatives.