CJR-X Opportunity & Risk Engine

01 · Find your hospital

Per-hospital opportunity ranking

Top 500 by opportunity score. Filter, then click a row for the full CJR-X profile.

Swipe sideways to see all columns →

Score	Hospital	CQS tier (est.)	Volume	Est. 90-day spend	Discount (CQS-adj.)	Repay / gain cap	PRO-PM $/yr	Readmit ERR
Initializing DuckDB-WASM and loading parquet…

Can't find a hospital? The universe is 2,663 acute-care hospitals with reportable Medicare FFS LEJR activity in the CMS provider-service files. A hospital may be absent if all its counts fall under the federal suppression threshold (11), if it bills under a parent CCN, or if it is not paid under IPPS (CAHs, REHs, Maryland). Try the CCN, the city, or a partial name. Still missing? Tell us.

02 · Geographic Distribution

Where the exposure sits

Every dot is a hospital, colored by its estimated CQS tier and sized by spend. Cluster rings show the tier mix underneath; zoom or click a ring to open it. Switch layers for cost, readmission risk, exposure, IPPS price, or the HCHR focus list. The map follows the filters above; the state and division tiles below re-filter the table.

Excellent (est.) Good (est.) Acceptable (est.) Below Acceptable (est.)

Top states · flat 2% of anchor spend

Pricing regions (§ 512.640 Census divisions) · est. average episode cost

Proposed → FinalWhat the final rule kept, what it changed, and how this engine models itNine provisions, each cited to 42 CFR § 512, plus the timeline to PY1.+

Provision

Proposed (CMS-1849-P)

Final (CMS-1849-F) · how modeled here

Status

Start date & cadence

PY1 Oct 1, 2027 · federal fiscal years

PY1 Jan 1, 2028 · calendar years. No end date (§ 1115A(c) expansion). TEAM hospitals roll in Jan 1, 2031.

§ 512.630(a) · § 512.605

Changed

Discount factor

Flat 2.0%; quality tiers reduce it (amounts unstated)

2.0% in the preliminary target; at reconciliation Excellent → 0.0%, Good → 1.0%, Acceptable → 2.0%, Below Acceptable → 2.0% and no reconciliation payment. Engine computes both the flat and CQS-adjusted exposure per hospital.

§ 512.640(b)(8) · § 512.645(h)

Kept · specified

CQS thresholds & points

Five measures; thresholds "to be finalized"

Excellent ≥17.1 · Good 12.1–17.0 · Acceptable 6.1–12.0 · Below ≤6.0 on a 20-point scale. Percentile-to-points tables published (10/8/2-point measures). Missing measures score at the 50th percentile. Engine rebuilds the CQS from public analogs of the exact measures.

§ 512.635(b)–(d)

Kept · specified

Stop-loss / stop-gain

5% stop-loss for safety-net; standard limit unstated

−20% / +20% of the aggregated reconciliation target for all hospitals; −5% stop-loss (still +20% gain) for MDH, rural, safety-net, and SCH. No glide path. Engine flags each hospital's likely corridor from Impact-File and dual-share data.

§ 512.650(c)(6)

Kept · specified

Low-volume floor

<31 episodes "in the baseline period"

<31 LEJR episodes across the three-year baseline → no target price, no reconciliation that year; reassessed annually. Public data are single-year, so the engine shows both the conservative ≥31/yr flag and a "≥11/yr → in scope over three years" projection.

§ 512.605 · § 512.640(a)(4)

Kept · clarified

Benchmark geography

100% regional, 3-yr baseline

Nine Census divisions × MS-DRG/HCPCS episode type; baseline weighted 17/33/50; annual rebasing; ±3% trend and ±5% normalization corrections; 99th-percentile outlier cap. Engine's benchmark proxy now uses Census-division averages instead of state averages.

§ 512.640 · § 512.645

Kept

Risk adjustment

29 adjusters (TEAM-derived)

29 adjusters, finalized: hospital bed-size tier + safety-net status; age, HCC count, 21 HCC flags, economic risk, five prior-procedure flags, prior PAC, disability entitlement; 180-day lookback. Engine shows the two hospital-level factors; beneficiary-level factors are not public.

§ 512.645

Kept

Fraud-and-abuse posture

CJR-style waivers assumed

No model-specific Stark/AKS waivers. Gainsharing runs through the CMS-sponsored-model safe harbor (42 CFR § 1001.952(ii)) and existing value-based exceptions.

§ 512.690

Restructured

Cyber-event episode cancellation

—

Cyberattacks that corrupt participant data qualify under the extreme-and-uncontrollable-circumstances policy.

§ 512.630(e)

New

Now → 2027

Baseline is already closed

PY1 target prices draw on the three baseline years ending before 2028. Preliminary target prices arrive by end of November each year (§ 512.640).

2027

Quality clocks start early

CQS measure performance periods run ahead of the performance year and follow existing IQR/OQR cadences (see the measure-period table in the rule).

Jan 1, 2028

PY1 begins

Calendar-year performance years. Full two-sided risk from day one; corridors −20/+20 (−5 protected).

Mid-2029

First reconciliation

Six months after PY1 ends, with claims run-out; 30-day calculation-error window (§ 512.650, § 512.660).

Jan 1, 2031

TEAM hospitals join

TEAM ends Dec 31, 2030; its ~741 hospitals become CJR-X participants the next day (§ 512.610(b)).

Read meWhat CJR-X is, what the columns mean, and how to use this toolGlossary, column definitions, and a quick start.+

▸The big pictureWhat is CJR-X?

CJR-X (Comprehensive Care for Joint Replacement — Expanded) makes acute-care hospitals financially accountable for the full 90-day episode around a Medicare hip, knee, or ankle replacement: the surgery, the stay, and everything related that follows (post-acute care, physician services, readmissions, Part B). It was finalized in the FY 2027 IPPS rule and starts January 1, 2028. It is mandatory for hospitals paid under both IPPS and OPPS in the 50 states, DC, and the territories, and it has no end date.

Each year CMS sets a regional target price per episode type. If a hospital's total episode spending comes in below the target it receives a reconciliation payment; above it, it repays Medicare. CMS builds a 2.0% discount into the preliminary target as its guaranteed share, then adjusts that discount at reconciliation by the hospital's Composite Quality Score: Excellent hospitals give up nothing (0%), Good hospitals give up 1%, Acceptable hospitals the full 2%, and Below Acceptable hospitals the full 2% and forfeit any reconciliation payment.

Repayments and payments are capped at 20% of the hospital's aggregate target; MDH, rural, safety-net, and sole-community hospitals get a 5% repayment cap. Hospitals with fewer than 31 episodes across the three-year baseline are low-volume: no target price, no reconciliation that year.

Why it matters. Roughly 2,400 hospitals and more than $10 billion in estimated 90-day episode spending are in scope. Under the flat 2% the aggregate discount is a bit over $200M a year; the quality-adjusted number is smaller because the average hospital lands near Good. The corridors are the larger figure: at −20% the aggregate repayment ceiling runs into the billions. This tool shows where each hospital sits on all three.

▸Key termsGlossary

LEJR
Lower-extremity joint replacement: hip, knee, or ankle replacement paid under MS-DRG 469, 470, 521, 522 (inpatient) or HCPCS 27447 / 27130 (hospital outpatient). Hip-fracture arthroplasty, including hemiarthroplasty, groups to 521/522 and is in.
CQS
Composite Quality Score, 0–20. Five measures across inpatient and outpatient episodes, weighted 50% complications / hospital visits, 40% CAHPS, 10% PRO-PM, then volume-weighted by the hospital's IP/OP episode mix (§ 512.635).
CQS tier
Excellent ≥17.1 · Good 12.1–17.0 · Acceptable 6.1–12.0 · Below Acceptable ≤6.0. Sets the discount at reconciliation (0 / 1 / 2 / 2%) and, for Below Acceptable, blocks reconciliation payments.
Discount factor
The 2.0% CMS subtracts from the regional benchmark to form the preliminary target price; adjusted by CQS tier at reconciliation (§ 512.640(b)(8), § 512.645(h)).
Stop-loss / stop-gain
Caps on annual repayment / reconciliation payment: 20% of the aggregated reconciliation target price (5% repayment cap for MDH, rural, safety-net, SCH). Post-episode spending above 3 SD (days 91–120) is repayable outside the cap (§ 512.650(c)).
Safety-net hospital
Top 25th percentile in its region for the share of Medicare LEJR episodes furnished to dually eligible beneficiaries in the baseline (§ 512.605). One of two hospital-level risk adjusters, and a 5% stop-loss trigger.
Low-volume hospital
Fewer than 31 LEJR episodes in the three-year baseline. No target price and no reconciliation for that performance year; status reassessed annually.
ERR
Excess Readmission Ratio (HRRP THA/TKA). Not a CQS measure, but readmissions land inside the 90-day episode, so a high ERR is an episode-cost risk signal. Kept in the opportunity score for that reason.
RSCR
Risk-Standardized Complication Rate after elective primary THA/TKA (CMIT #350). The 10-point inpatient complications measure in the CQS; publicly reported on Care Compare as COMP-HIP-KNEE.
OP-36
Hospital visits within 7 days of hospital outpatient surgery (CMIT #344). The 10-point outpatient measure.
PRO-PM
THA/TKA patient-reported outcome performance measure (CMIT #1618). 10% of the CQS, pay-for-performance from PY1. Not yet publicly reported, so every hospital receives the 50th-percentile default here (as CMS does for missing values). Also the IQR measure whose non-reporting triggers the separate market-basket penalty modeled below.
CCN
CMS Certification Number, the six-digit hospital identifier used to join all files.

▸Reading the numbersWhat the columns mean

Opportunity score (0–100)
Ranks hospitals by dollars at stake times readiness gap: est. episode spend (35%), readmission headroom (30%), CQS gap to 20 (20%), CJR-era complication percentile for alumni (15%). Higher = more money and more room to move. Not a judgment of quality.
Anchor spend
Medicare payment for the anchor admission (Part A) or anchor procedure (OPPS facility) in the most recent public year. Medicare FFS only.
Est. 90-day total
Anchor spend × 1.65, a national-average planning multiplier (anchor ≈ 60% of a 90-day LEJR episode in the CJR evaluation literature). Hospital-specific post-acute patterns will move the true figure in either direction.
CQS-adjusted discount
Est. 90-day total × the hospital's estimated CQS-tier discount (0 / 1 / 2%). The flat-2% figure is shown underneath for comparison.
Stop-loss / gain
Maximum annual repayment at the hospital's estimated corridor (−20%, or −5% if protected) and maximum reconciliation payment (+20%).
PRO-PM $/yr
The separate Hospital IQR penalty for not reporting the THA/TKA PRO-PM: one-quarter of the market-basket update applied to the hospital's operating IPPS revenue. Applies to all Medicare inpatient revenue, not just joints.
CQS (est.) and tier
Our estimate of the hospital's CQS from public analogs of the five measures, with the number of measures actually observed shown as filled dots (●●●○ = 3 of 4 public measures; PRO-PM is always defaulted).
Badges
≥31/yr clears the low-volume floor with certainty; 3-yr in scope means 11–30 episodes/yr, which projects to ≥31 over the baseline; −5% cap marks a likely protected corridor; CJR, HRRP, HCHR, urban/rural, and deprivation-decile pills as before.

Why the volumes look small. Public files count Medicare fee-for-service claims only. Medicare Advantage (about half of beneficiaries), commercial, Medicaid, and VA are excluded, and counts under 11 are suppressed. A hospital doing 500 joints a year may show 80–120 here.

▸How to use itQuick start

1. Search or filter. Type a hospital name, city, or CCN above, or open the filter chips (state, Census division, star rating, CQS tier, stop-loss corridor, eligibility, setting, geography, deprivation, volume, HCHR).

2. Click a row. The detail panel shows the CQS build-up measure by measure, the flat vs. quality-adjusted discount, the stop-loss corridor and its basis, the regional target comparison, DRG-level volume, the FY 2026 IPPS pricer, the PRO-PM penalty, HRRP history, and CJR alumni data. Arrow keys move between hospitals; Esc closes.

3. Map it. Dots are colored by estimated CQS tier; switch layers for cost, readmission risk, exposure, IPPS price, or the HCHR focus list. Click a division pill under the map to filter to a pricing region.

4. Check the methods. Every source, join, weight, and threshold is documented in Methods; every rule parameter is cited to its section in Rule.

What this is not. A planning workbench, not a reconciliation. CMS has not published participant lists, target prices, risk-adjustment coefficients, or PRO-PM results. Read it alongside the rule text.

03 · Equity & Cost Analysis

Where cost and community disadvantage intersect

Descriptive analysis of per-episode unit cost across urban-rural geography, community deprivation (proxied by the CMS dual-eligible proportion), and procedural volume. Observational; restricted to hospitals with ≥31 LEJR episodes in the public year.

0.50

Pearson r · cost per episode vs. dual-eligible share

Every 10-point rise in dual-eligible share predicts a meaningful rise in inpatient cost per episode.

28%

Cost gap · higher- vs. lower-deprivation hospitals

Mean IP LEJR cost/episode — $16,897 (D8–10) vs. $13,246 (D1–3).

194

High-Cost High-Risk hospitals

Top-quartile unit cost AND (ERR > 1.0 OR HRRP penalized). Flagged on the map.

F1Unit cost rises monotonically with community deprivation decile

Each cell is the mean inpatient Medicare payment per LEJR episode among hospitals in that decile of dual-eligible share (1 = lowest, 10 = highest).

n shown in each cell · IQR (p25–p75) on hover · excludes hospitals below 31 episodes/yr.

F2Cost by urban-rural classification

Density-derived (neighbors within 10 & 25 miles). The CMS CBSA rural flag used for the stop-loss proxy is separate.

F3Cost by community deprivation tier

Lower = deciles 1–3; Moderate = 4–7; Higher = 8–10.

F4Cost by annual LEJR volume

31 episodes across three years is the rule's floor; 31/yr is the conservative single-year read.

F5Dual-eligible-to-cost slope by urban-rural stratum

Simple OLS of inpatient cost/episode on dual-eligible proportion, by stratum.

Slope: coefficient on dual-eligible share, expressed per 10 pp.

Why this matters under the final rule

Targets are regional and risk-adjusted, and the two hospital-level adjusters are bed size and safety-net status, the latter a cliff at the 25th percentile of regional dual-eligible LEJR share (§ 512.645). A high-deprivation hospital just below that line gets neither the safety-net adjuster nor the 5% stop-loss, faces the regional average with the higher unit costs shown above, and, if its CQS lands ≤6.0, cannot earn a reconciliation payment at all. The 5% corridor (§ 512.650(c)(6)(iii)) caps repayment; it does not lift the target. The HCHR list is the practical focus set for readiness work.

Analytical note — the dual-eligible proportion is the CMS SES peer-grouping variable used in HRRP since FY 2019 (21st Century Cures Act § 15002). It correlates with tract-level Area Deprivation Index and is available at the hospital level without geocoding. The rule's own safety-net test uses LEJR-episode-specific dual share, which is not public; see Methods.

04 · Adjacent Exposure

Hospital IQR PRO-PM penalty module

Separate from CJR-X, and larger for most hospitals: failing to report the THA/TKA PRO-PM under Hospital IQR costs one-quarter of the market-basket update on all Medicare IPPS revenue. The same PRO-PM is 10% of the CJR-X CQS.

IQR PRO-PM penalty exposure · filtered set

FY 2028 payment determination onward · modeled on FY 2026 operating IPPS revenue

Market basket update % Fraction forfeited

PRO-PM exposure (filtered)

—

filtered hospitals · 0.800% × operating IPPS base

Effective rate applied

0.800%

fraction × market basket (FY 2027: 3.2%)

Modeled operating IPPS base

—

Σ operating IPPS payments, filtered set (FY26 Impact File)

Impact-File matches

—

of filtered set · gaps explained in Methods

Derivation, sources, and caveats

Statutory basis. Section 1886(b)(3)(B)(viii)(I) of the Social Security Act reduces the applicable percentage increase by one-quarter of the market basket update, determined without regard to the productivity adjustment, for any subsection (d) hospital that does not submit required Hospital IQR data. The FY 2027 final rule restates the mechanics: market basket 3.2%, so the IQR reduction is 0.8 point (a hospital that is also not a meaningful EHR user lands at −0.9%). CMS made the THA/TKA PRO-PM (CMIT #1618) a required IQR submission beginning with the FY 2028 payment determination; the reporting threshold is ≥50% of eligible elective primary THA/TKA cases with matched pre- and post-operative PROMs.

Formula. PRO-PM penalty $ = 0.25 × market basket % × operating IPPS revenue. Default 0.25 × 3.2% = 0.8% of operating IPPS revenue per year. The FY 2028 market basket is unpublished; 3.2% is the best available proxy and is user-overridable above.

Operating IPPS revenue, per CCN, is reconstructed from the CMS FY 2026 IPPS Final Rule Impact File with CMS's own payment logic: standardized amount = labor rate × wage index + non-labor rate × COLA (Tables 1A–1C); operating federal per weight = standardized amount × (1 + TCHOP + DSHOPP); scaled by CASETA43 × TACMIV43. Capital, UC per-claim, outliers, SCH hospital-specific rates (Provider Type 16/17), MDH-flagged hospitals paid on HSP rates, VBP/HRRP/HAC adjustments, and pass-throughs are excluded because the statute adjusts the standardized amount only. Hospitals absent from the Impact File (not IPPS-paid, new CCNs, sub-providers) show no PRO-PM value and are excluded from the aggregate; the match count above surfaces the gap.

Read as a planning figure. Actual exposure is the reduction to the following year's standardized amount across that year's discharges; the projection here uses current volumes and rates, typically within ±5–10% of the realized figure.

05 · Data & Methodology

Ten public CMS files, joined on CCN, scored against the final rule

No proprietary claims, no private feeds. Every weight, threshold, and proxy is documented here so it can be argued with.

▸Click to collapseSources, joins, scoring, and every proxy we make

Hospital universe & geocoding

Acute-care hospitals from Hospital General Information (star rating, address). Any CCN reporting inpatient trigger-DRG or APC 5115 activity. 2,569 of 2,663 geocoded via 2024 Census ZCTA centroids; the rest are retained in tables and aggregates.

data.cms.gov · xubh-q36u · Census Gazetteer

Inpatient & HOPD LEJR exposure

IP: Σ discharges × avg Medicare payment across MS-DRG 469/470/521/522 (Part A, anchor only). HOPD: Σ services × avg payment for APC 5115, the comprehensive APC carrying HCPCS 27130/27447 (facility only; a small share of non-LEJR level-5 MSK cases rides along). Counts under 11 are suppressed.

Medicare Inpatient by Provider & Service · Medicare Outpatient by Provider & Service

90-day episode estimate

Anchor × 1.65. The CJR evaluation literature puts the anchor hospitalization near 60% of a 90-day LEJR episode; the remainder is SNF/IRF/HHA, physician, readmissions, Part B. National average, so a SNF-heavy hospital is understated and a home-health-heavy one overstated. Every dollar figure downstream of this is a planning estimate.

Barnett et al., NEJM 2019;380:252 · CMS CJR PY6–7 evaluation

Low-volume test (§ 512.605)

The rule excludes hospitals with fewer than 31 episodes across the three-year baseline. Public data are one year, so we show two flags: ≥31/yr (certain) and in scope (3-yr) for 11–30/yr, which projects to ≥31 over three years. Suppressed HOPD counts make both flags conservative for roughly 370 hospitals.

CMS-1849-F · § 512.605, § 512.640(a)(4)

CQS proxy (§ 512.635) — the core change in v5

We rebuild the CQS from public analogs of the five measures: COMP-HIP-KNEE RSCR (Complications & Deaths file, ≥25 cases) for CMIT #350; the HCAHPS linear-mean roll-up (≥100 surveys) for #338; OP-36 from Unplanned Hospital Visits (≥25) for #344; the OAS CAHPS HOPD linear-mean roll-up (≥100 surveys) for #162; and the 50th-percentile default for the PRO-PM (#1618), which CMS has not published. Each measure is converted to a national performance percentile and then to points using the rule's own tables (10.00/9.25/…/5.50/0 for complications and OP-36; 8.00/…/5.00/0 for CAHPS; 2.00/…/1.10/0 for PRO-PM). Inpatient and outpatient composites (each capped at 20) are volume-weighted by the hospital's IP/HOPD episode mix. Tier thresholds are the rule's: ≥17.1 / 12.1 / 6.1.

Known gaps: percentiles run across all hospitals with a reportable value rather than CMS's IPPS-eligible denominator; measurement periods (COMP 4/2023–3/2025, HCAHPS & OAS 10/2024–9/2025, OP-36 CY2024) precede the PY1 windows; the HCAHPS point table as published gives 5.40 at the 30–39th percentile and 5.00 at 40–49th, which we apply as written. Spend-weighted, the estimated average effective discount is 1.29%, against CMS's impact-analysis assumption of 1.3%.

ynj2-r877 · dgck-syfz · 632h-zaca · yizn-abxn · catalog refresh 2026-07-22

Discount & corridors (§ 512.645(h), § 512.650)

Flat exposure = est. 90-day spend × 2.0%. CQS-adjusted exposure = est. spend × {0, 1, 2, 2}% by tier; Below Acceptable also loses reconciliation-payment eligibility. Stop-loss = est. spend × 20% (or 5% if the hospital is flagged MDH, rural, safety-net, or SCH); stop-gain = est. spend × 20% for everyone. The rule applies these to the aggregated reconciliation target price, which we do not observe; est. spend is the stand-in.

CMS-1849-F · § 512.645(h) · § 512.650(c)(6)

Stop-loss & hospital-level risk-adjuster proxies

Safety-net: the rule's test is top-25th-percentile within region for dual-eligible share of Medicare LEJR episodes. We use the FY 2026 IPPS Provider Beneficiary Characteristic PUF (dual-enrolled share of all discharges) ranked within Census division among hospitals in this universe. Rural: URGEO = RURAL in the FY 2026 Impact File (geographic CBSA); URSPA rural-for-payment reclassifications are shown but not counted. SCH: Provider Type 16/17. MDH: Impact File flag. Bed-size tier (≤250 / 251–500 / 501–850 / 851+): Impact File beds. Any of the first four → 5% stop-loss.

FY 2026 IPPS Final Rule Impact File · Beneficiary Characteristic PUF

Regional target proxy (§ 512.640)

Nine Census divisions map to state. Preliminary target = division average est. episode cost × (1 − 2.0%); reconciliation target = × (1 − CQS-adjusted discount). Not modeled: episode-type split (36 benchmark prices), 17/33/50 baseline weighting, risk adjustment, trend/normalization, the 99th-percentile outlier cap. Directional only.

state → Census division crosswalk · engine SQL

Readmission risk & HRRP history

HRRP THA/TKA ERR (FY 2025 and FY 2026 supplemental files): payment adjustment factor, THA/TKA trigger flag, peer group, dual proportion. Readmissions are inside the 90-day episode, so ERR stays in the opportunity score as a cost-risk signal even though it is not a CQS measure.

9n3s-kdb3 · HRRP supplemental files

CJR alumni prior

297 hospitals from the original CJR Model. Published complication and HCAHPS percentiles serve as a directional prior on the closest CJR-era analog to the CQS complications domain.

tqkv-mgxq

Opportunity score (0–100)

0.35 × log10(anchor spend), normalized
0.30 × readmission headroom: clip((ERR − 0.80) × 250, 0, 100); missing → 50
0.20 × CQS gap: (20 − est. CQS) / 20 × 100
0.15 × CJR complication percentile (alumni; 50 otherwise)

v4 used star-rating headroom in the 20% slot; v5 swaps in the CQS gap because the star rating is not a CJR-X input.

deterministic · scripts/enrich_final_rule.py

IPPS pricer & PRO-PM base

Per-DRG federal payment and per-CCN operating revenue reconstructed from the FY 2025/2026 IPPS Final Rule Impact Files and Tables 1A–1E/5. See the PRO-PM module above for the formula and exclusions.

CMS-1808-F · CMS-1833-F · scripts/build_ipps_prices.js

Query engine

Browser-resident DuckDB-WASM 1.29. Parquet (zstd) is loaded once; filters compile to SQL against an in-memory view. No server. Source in app.js.

DuckDB-WASM

06 · Rule Specification

CJR-X parameters · CMS-1849-F · 42 CFR Part 512, Subpart F

Status

Final rule, published 91 FR 49570 (Aug 4, 2026; displayed Jul 31). Section 1115A(c) expansion of the CJR Model: no end date.

CMS-1849-F

Performance years

PY1 begins Jan 1, 2028; calendar-year PYs; episodes initiated on/after that date. Reconciliation six months after each PY.

§ 512.605 · § 512.630(a) · § 512.650(b)

Participation

Mandatory for acute-care hospitals paid under both IPPS and OPPS that initiate LEJR episodes. Excluded: TEAM participants (join Jan 1, 2031), Maryland hospitals; CAHs, REHs, IHS/Tribal, and RCH demonstration hospitals by definition.

§ 512.610

Episode triggers

MS-DRG 469, 470, 521, 522 (inpatient; 469 title includes total ankle) · HCPCS 27447, 27130 (HOPD). Outpatient TAA and unicompartmental knee excluded.

§ 512.605 (LEJR) · § 512.625

Episode window

Anchor hospitalization/procedure through 90 days post-discharge; all related Part A and B services; standard exclusions list on the CMS website.

§ 512.630 · § 512.625

Low-volume

Fewer than 31 LEJR episodes in the three-year baseline: no preliminary target price and no reconciliation for that PY; reassessed each year.

§ 512.605 · § 512.640(a)(4)

Target price

Regional benchmark (nine Census divisions × MS-DRG/HCPCS episode type), three-year baseline weighted 17/33/50, rebased annually; risk adjustment; prospective trend (retrospective correction capped ±3%); normalization (correction capped ±5%); 99th-percentile high-cost outlier cap; then the discount. Preliminary prices by end of November each year.

§ 512.640 · § 512.645

Discount factor

2.0% in the preliminary target. At reconciliation: Excellent (CQS ≥17.1) → 0.0%; Good (12.1–17.0) → 1.0%; Acceptable (6.1–12.0) → 2.0%; Below Acceptable (≤6.0) → 2.0% and ineligible for a reconciliation payment.

§ 512.640(b)(8) · § 512.645(h) · § 512.650(d)

Quality measures

Inpatient: RSCR THA/TKA (#350, 50%), HCAHPS (#338, 40%), PRO-PM (#1618, 10%). Outpatient: OP-36 hospital visits after HOPD surgery (#344, 50%), OAS CAHPS (#162, 40%), PRO-PM (10%). Composites capped at 20; overall CQS volume-weighted by episode mix. Minimums 25 cases / 100 surveys; missing → 50th-percentile points.

§ 512.635

Risk adjustment

Hospital: bed-size tier (≤250 / 251–500 / 501–850 / 851+), safety-net status (top 25th percentile regional dual-eligible LEJR share). Beneficiary: age bracket, HCC count, 21 HCC flags, economic risk (dual/LIS/CDI), five prior-procedure flags, prior PAC use, disability entitlement; 180-day lookback. Coefficients published before each PY.

§ 512.645(a)–(c)

Stop-loss / stop-gain

Repayment capped at 20% of the aggregated reconciliation target price (5% for MDH, rural, safety-net, SCH); reconciliation payment capped at 20%. Post-episode spending (days 91–120) > 3 SD above regional average is repayable outside the caps.

§ 512.650(c)(6)–(7)

Financial arrangements

Sharing, distribution, and downstream arrangements with 15 collaborator types; gainsharing up to 100% of the reconciliation payment (no per-physician cap); alignment payments capped at 50% aggregate / 25% per collaborator. No model-specific Stark/AKS waivers; CMS-sponsored-model safe harbor applies.

§§ 512.670–512.690

Waivers

Telehealth originating-site/geography with new G-codes; SNF 3-day rule for ≥3-star SNFs (swing beds exempt); up to nine post-discharge home visits per episode under general supervision.

§ 512.695

Beneficiary incentives

Technology items up to $1,000 per episode; retrieval above $75; documentation above $25; written beneficiary notification before discharge.

§ 512.685

Impact (RIA)

CMS projects $129M net Medicare savings in PY1 rising to $171M in PY5; five-year net savings ≈ $736M ($1.463B paid to participants, $1.855B repaid, plus a 1% behavior-change assumption).

CMS-1849-F § XII

Sources: Federal Register · 2026-15833 (full text) · CMS fact sheet, FY 2027 IPPS final rule · CMS Innovation Center · CJR-X model page · CJR Model (2016–2024)

07 · Read Next

Primary sources and the Techy Surgeon coverage

The Operator's Guide to CJR-X

The long-form walkthrough of the model, section by section, with the comment-letter scorecard and the operational read (fracture book, ASC decant, care navigation). Final-rule edition on Substack.

techysurgeon.substack.com

CJR-X: The Mandatory Era (scroll world)

The narrated seven-scene explainer of the model's mechanics, in the Techy Surgeon worlds shelf.

techysurgeon.com/worlds/cjrx

Final rule text

FY 2027 IPPS/LTCH PPS final rule, CMS-1849-F. CJR-X policy is section X.C; regulatory text at 42 CFR §§ 512.600–512.695.

federalregister.gov · 2026-15833

CMS CJR-X model page

Model summary, participant information, FAQs, and the CJR-X listserv.

cms.gov · CJR-X

Hospital quality data behind the CQS proxy

Complications & Deaths, HCAHPS, Unplanned Hospital Visits, and OAS CAHPS on the Provider Data Catalog.

data.cms.gov · Provider Data Catalog

The Policy Radar

Where this tool lives alongside the rest of the Techy Surgeon policy toolkit.

techysurgeon.com/policy

08 · Work With Us

Prepare for CJR-X

This engine is built and maintained by Christian Péan MD, MS (orthopedic trauma surgeon, Duke faculty) for Techy Surgeon. CJR-X analytics and care-navigation deployments run through RevelAi Health, where he is CEO.

Tell us about your hospital

Hospital-specific CQS modeling, episode-cost analysis, PRO-PM capture, and post-acute navigation design. We reply within one business day.

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Message sent

We'll get back to you within one business day. In the meantime, keep exploring the engine or read the Operator's Guide.

Techy Surgeon Studio

Advisory, talks, and custom analysis for health systems, societies, and med-tech teams working through mandatory episodes.

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RevelAi Health

AI care navigation and episode analytics for TEAM, CJR-X, and the ACCESS Model, deployed with health systems and PT partners.

revelaihealth.com