Selling Joints Under the New CMS Rules
Medicare joint replacement is officially a permanent bundled-care market—not a pilot, not a test.
Price still matters, but clinical proof that your construct lowers 90-day total cost without sacrificing quality scores matters significantly more.
The ASC remains a preference-driven environment; the hospital is now an episode-managed market.
Build your commercial engine to sell to both, or watch your hospital business walk to the competitor who can.
1/ The Playbook: Mandatory Bundles Are No Longer a Pilot
It kicks off January 1, 2028, under the FY 2027 Inpatient Prospective Payment System (IPPS) final rule. If your hospital is paid under both inpatient and outpatient systems, you’re in. The exit doors are narrow—limited mostly to hospitals already running TEAM, Maryland facilities, and non-IPPS/OPPS systems. When TEAM wraps up, those facilities roll right into CJR-X too. CMS is dropping more than 2,200 hospitals straight onto the participant list with no expiration date. Bundles are now standard operating procedure.
2/ The Mechanics: Target Prices, 90 Days, and Two-Sided Risk
Hospitals keep billing standard fee-for-service upfront, then face...
