The end of the CJR model: A look back at its evolution
In October 2024, the final episodes of the Comprehensive Care for Joint Replacement (CJR) model were initiated, with all episodes ending by Dec. 31, 2024. This was the final performance year of CJR, which spanned eight years overall.
CJR began Apr. 1, 2016. It was CMS’ first mandatory bundled payment model. Hospitals were held financially accountable for lower extremity joint replacement (LEJR) episodes of care and were incentivized to improve care coordination for patients across the continuum.
Key insights from CJR: Successes, adjustments and challenges
CJR had numerous ups and downs over the years, as its scope was adjusted over several administrations through the rule-making process. Here are the five main highlights.
1. CJR’s mandatory participation: A changing landscape
When the CJR model was introduced, participation was mandatory for hospitals in 67 metropolitan statistical areas (MSAs) across the country. However, in February 2018, CMS reduced the number of required participants to hospitals located in 34 MSAs. This shift allowed many hospitals in the removed MSAs to exit the program while some continued to participate on a voluntary basis through the end of performance year 5.
2. Expanding hospital episode-based care: From inpatient to outpatient
Initially, CJR focused on 90-day episodes of care following LEJR procedures performed in the inpatient hospital setting. Over time, as Medicare policy evolved, some of these procedures were removed from the Medicare inpatient-only list, impacting CMS’ ability to evaluate the model. During CJR’s three-year extension, CMS made a change to include LEJR episodes initiated in the outpatient hospital setting, broadening the scope of CJR and improving the ability to assess the model’s impact.
3. Target price transitions
CJR’s payment methodology underwent significant changes throughout its performance years. Initially, target prices were based on a hospital’s historic Medicare episode spend. Over time, CMS blended the influence of the hospital’s and its region’s historic Medicare episode spend to produce target prices. By performance year four, target prices were fully based on regional Medicare episode spend.
When it came to risk adjustment, DRG and fracture status were the sole factors considered for the first five performance years. Later, under the three-year CJR extension, CMS incorporated additional risk adjustments for factors such as beneficiary age group, dual eligibility status and comorbid conditions.
4. Quality measures and patient experience in CJR
Beyond Medicare cost containment, CJR included consideration for quality of care. Financial performance was influenced by complication rates for elective procedures and patient experience measures. Additionally, hospitals had the option to collect and submit patient-reported outcomes data, further integrating patient-centered care into the model’s success metrics.
5. CJR extensions: The impact of COVID-19 and policy changes
Like many healthcare programs, CJR saw significant changes due to the COVID-19 pandemic. CMS introduced temporary flexibilities and later extended the model by three years to accommodate shifts in Medicare payment policy and refine the program’s methodology. A total of 324 hospitals across 17 states participated in this extension, providing valuable insights into the long-term viability of CMS mandatory bundled payment models.
Final performance results: What to expect
Hospitals that participated in CJR won’t know their individual performance results for the final performance year until they are released by CMS at the end of 2025. Furthermore, we likely won’t see the final model evaluation for CJR until late 2027.
Lewin Group’s most recent CMS CJR model evaluation for performance year 6 indicated reductions in LEJR Medicare episode-based payments driven by decreases in facility-based post-acute care, statistically significant Medicare savings of $54.4 million in performance year 6 alone and no decrease in care quality.
Introducing TEAM: The future of CMS bundled payment initiatives
While this is the end of CJR, CMS has not turned away from mandatory episodes of care as a strategy to reduce fragmented care and improve patient experience. In fact, CJR and its successes have laid the groundwork for the new mandatory Transforming Episode Accountability Model (TEAM) which will impact 741 acute care hospitals across the country beginning on Jan. 1, 2026.
TEAM is largely modeled after the design of the CJR three-year extension with a few notable differences:
30-day episodes of care for five common surgical procedures;
availability of three participation tracks with varying levels of risk and reward; and
additional complexity in creating risk-adjusted regional target prices.
TEAM participation: What hospitals need to know
Some hospitals that participated in CJR will again have mandatory participation in TEAM if they are in one of the selected Core-based Statistical Areas (CBSA). View CMS’ list of acute care hospitals.
CJR hospitals that are not located in a mandatory CBSA have had the option to voluntarily participate in TEAM. This option was also extended to hospitals that are still participating in the Bundled Payments for Care Improvement Advanced (BPCIA) model. Hospitals seeking voluntary participation had to submit a voluntary participation election letter to CMS by Jan. 31, and will be required to participate in all included episode categories across the full model’s duration.
Beyond TEAM: the future of bundled payment models in healthcare
Hospitals that have previously participated in bundled payment arrangements will certainly have an advantage when it comes to knowing what to expect if participating in TEAM. Regardless of previous bundled payment experience, hospitals will need to ramp up awareness of the model among staff, evaluate potential care redesign activities and assess how well their own hospital is positioned for the model.
Aside from mandatory models, CMS is still testing additional acute episodes of care in the voluntary BPCIA model, which is set to run through the end of 2025.
It’s unknown if there will be another voluntary-based model for the hospitals located in a region not selected for TEAM and not eligible for a voluntary opt-in. Hopefully the industry will learn where CMS is headed next when it comes to voluntary episodes of care in the coming year.
Get ready for TEAM: Must-have expert resources
Preparing for the CMS TEAM requires staying informed and taking proactive steps to ensure successful participation. Regularly consulting CMS’ TEAM webpage for updates and completing the necessary data request and attestation form will help your hospital gain access to critical claims data before the model launches.
To support your readiness, DataGen offers a suite of resources, including:
[CMS TEAM Readiness Checklist] – DataGen’s checklist that lists key steps to prepare before the model launches.
[Model Overview Webcast] – Center for Medicare and Medicaid Innovation’s TEAM webinar slides.
[What is TEAM?] – A white paper detailing the essential components of the CMS TEAM.
[CMS TEAM Q&A] – Answers to the most pressing questions from the webinar, Unpacking the mandatory CMS TEAM Model: Overcome new rules & challenges. This is a deep dive into TEAM’s biggest challenges and strategies to overcome them.
[Using Shadow Bundle Data to Prepare for TEAM] – A webinar with the Association of American Medical Colleges (AAMC) on leveraging data for better preparation. (Zoom passcode: +JhYE&4h)
By systematically addressing each step in your TEAM readiness plan, your hospital can improve patient care, avoid financial risk to gain optimal performance and confidently navigate mandatory participation.
Learn how our TEAM solution can help your hospital take control of its data and thrive under CMS’ new model, ranging from opportunity analysis to performance monitoring and reconciliation validation services.
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