On August 1, 2026, CMS finalized CJR-X (Comprehensive Care for Joint Replacement Expanded Model) in the FY2027 IPPS final rule. Beginning January 1, 2028, every acute care hospital in the country (with some exceptions) will be financially accountable for the cost and quality of lower extremity joint replacement (LEJR) episodes, from surgery through 90 days after discharge. CJR-X will be the first mandatory, nationwide, episode-based payment model CMS has ever rolled out.

CJR-X lands less than a year after the Transforming Episode Accountability Model (TEAM) went live on January 1, 2026, a few weeks after CMS announced a finalized Ambulatory Specialty Model (ASM) and a few months after adding the Information Transfer PRO-PM–which was already included in the Hospital Outpatient Quality Reporting (OQR) program for HOPD–into the list of quality measures for TEAM. For orthopedic and MSK leaders, the pattern is clear: large scale, mandatory, episode-based accountability that incorporates patient perspectives has arrived, and the pace at which Medicare is moving in this direction is accelerating.

The understandable instinct is to solve the challenges of each mandate as it lands. But the programs that stay ahead have stopped treating compliance as a series of one-off initiatives and started treating it as foundational infrastructure and part of a comprehensive organizational strategy.

The Mandate Cadence Is Accelerating

Consider what a single orthopedic service line may now be navigating inside a roughly 24-month window:‍

• TEAM: currently mandatory for 716 hospitals in selected Core-Based Statistical Areas, running January 1, 2026 through December 31, 2030. It covers five surgical episodes, including LEJR, with accountability for cost and quality across 30-day episodes.
• ‍CJR-X: mandatory and nationwide beginning January 1, 2028, covering 90-day hip, knee, and ankle replacement episodes in both inpatient and outpatient settings (excluding outpatient ankle replacements), with 20% stop-loss/stop-gain risk and a 2% discount applied to target prices. TEAM participants and Maryland hospitals are carved out to avoid overlap.‍
• ASM: a mandatory 5-year specialty model beginning in 2027 that extends episode accountability into conditions including low back pain, pulling more of the MSK pathway into value-based territory.‍
• PRO-PMs: the Hospital-Level THA/TKA PRO-PM is already a mandatory reporting measure for inpatient settings and will transition from voluntary to mandatory for HOPDs and ASCs for the 2028 performance period, while the Information Transfer PRO-PM is gradually impacting accountability beyond just the hospital outpatient setting. While the latter was not finalized for ASCs in the 2026 OPPS and ASC Final Rule, CMS may still propose to include it for later years.

With all of these programs, a hospital could easily find itself inside TEAM or CJR-X, reporting the THA/TKA PRO-PM, and meeting the Information Transfer PRO-PM all at the same time. The signal CMS is sending is that this is not a series of disparate events; it is the new standard operating landscape.

Why Solving One Mandate At A Time Breaks Down

Duplicated effort: Standing up a patient-reported outcome measures (PROMs) workflow for TEAM, then a separate one for CJR-X, then patching in the Information Transfer PRO-PM means rebuilding the same data collection process three times. The underlying work, from engaging the patient, to capturing the outcomes and reporting them in the correct format,  barely changes from model to model.

Staff burnout: The people who absorb the shortfall are the navigators and coordinators making the calls and chasing one-year surveys. Solving each new mandate with another standalone tool adds to the team's load instead of lightening it, and headcount almost never follows. A platform built to flex across mandates is what actually saves time.

Timing risk: A tool scoped tightly to one program can be outpaced by the next revision. An organization preparing exclusively for the THA/TKA PRO-PM may have found itself redoing a good deal of work to set up similar processes across different episode categories ahead of TEAM. Programs built around a single set of requirements can struggle when those requirements evolve.

What The Mandates Share Under The Hood

Strip away the acronyms and these models run on the same machinery. Every one of them rewards an organization that can:

• Engage patients consistently across the full episode, from pre-op preparation throughout the full recovery journey.
• Standardize evidence-based care pathways to reduce the clinical variation that drives cost and complications.
• Collect PROMs at the intervals CMS specifies, and treat them as performance, not paperwork–all without overburdening your care team or overspending on nonclinical staff.
• Shift appropriate recovery to the home and establish capabilities for remote triage to avoid unnecessary post-acute spend and adverse events.
• Give care teams real visibility into how patients are progressing across the episode, so that those underperforming get high-quality attention.

If we take PROMs as an illustrative example, these are no longer an administrative checkbox; they are a direct, quality-based input into reimbursement. An organization that has built PROMs collection well once is already positioned for TEAM, CJR-X, and any other PROMs based quality measure that may arise in the future.

What A Compliance-Ready Program Looks Like

The alternative to a stack of point tools is a single patient engagement, education, PROMs, and reporting layer that can flex and adapt to each model's idiosyncrasies. This is the approach we have built Force Therapeutics around, and the results bear it out: across our partners, we see an 82% PROMs collection rate and 83% active patient engagement, substantially above the federal thresholds these measures require. In a 22,000-patient THA/TKA analysis, our platform satisfied quality reporting requirements that contribute to TEAM success, using the same infrastructure and with no double work.

The real test of a compliance program is not whether it handles the mandate in front of you. It is whether it can grow with you and the next model’s requirements. When the next rule drops, will you have a source of truth that can tell you what it means and adapt the program you already run? Or will you have to start another procurement cycle all over again? The organizations we partner with increasingly want the former: not a vendor for CJR-X or TEAM, but a compliance partner for whatever CMS or other payers have planned next.

What You Can Do Now

If you lead an orthopedic service line or own value-based care strategy, a few moves will pay off regardless of which specific model touches your footprint:

• Map every model your organization touches (for employed and non-employed clinicians) now and over the next 24 months on a single timeline.
• Consolidate PROMs collection and patient engagement efforts into one workflow built to satisfy the strictest threshold.
• Treat PROMs performance as a reimbursement input, because soon it will be for virtually every hospital in the country now is.
• Choose infrastructure and a partner that can adapt to the next mandate rather than remain fixed to the current one.

To learn more about how leading institutions are using Force to adapt to every CMS mandate, get in touch with us: