The PT Seat at the Table: What CJR-X Means for Physical Therapy Providers & Organizations

CJR-X: A Model That Changes the Game

For physical therapists, bundled payment models have historically been something that "happened to them," or were just viewed as a downstream cost in someone else's decision tree.

The Complete Joint Replacement Expanded Model (CJR-X) changes that and gives physical therapy practices a seat at the table, but only for organizations that are watching how their market—and healthcare itself—is changing around them. PTs need to collect outcomes and provide meaningful digital solutions that align with the incentives in the model; otherwise, they won’t be an attractive partner. 

CMS recently announced CJR-X in the proposed IPPS rule, and it's scheduled to begin on October 1st, 2027. The episode covers every dollar spent on a hip, knee, or ankle replacement patient from the day of surgery through 90-days post-discharge—including all outpatient physical therapy during that window. Spending those post-acute dollars wisely will be the key to success for everyone in the model. 

The model follows a typical bundled-payment structure in that hospitals bear financial accountability for the episode cost when compared against a CMS-set target price based on the organization’s region’s past three years of claims. But in CJR-X, reducing costs isn’t enough—organizations need to hit a minimum quality score to unlock their reconciliation bonus down the line. 

Hospitals and health systems will focus heavily on CJR-X as the model offers a substantial 20 percent stop gain and stop loss, representing a significant opportunity if the organization can do well… and a real threat to their bottom line if ignored. 

PTs Are Essential Collaborators

CMS proposes allowing hospitals to enter into financial arrangements with a broad set of collaborating entities, including PT and OT. Collaborators can receive gainsharing payments from reconciliation proceeds and can help spread risk on the alignment payments if downside risk is part of their agreement with hospitals. 

Downside is likely to be included in these agreements as CJR-X doesn’t offer an upside-only track for the episode-initiator, as currently proposed. Allowing PTs to take part in the gainsharing deal is essential, but the other half of this is the quality aspect. 

CJR-X will require outcomes collection for the THA/TKA PRO-PM, a direct measure of patient functional recovery that sits squarely in PT's lane. PROs will count for 10 percent of the quality score, with complications and patient experience comprising the rest of the score.

CJR-X Quality Categories:

• Complications (50 percent): Minimizing postoperative surgical site infections and readmissions.

• Patient Experience (40 percent): HCAHPS survey results focusing on care transitions and communication.

• Patient-Reported Outcomes (10 percent): The successful collection and reporting of functional status data (TKA/THA PRO-PM).

CJR-X creates a reconciliation payment if the hospital comes in under cost and meets the minimum quality threshold (a score of 6.0 or higher). The payment is then shared under the documented gainsharing arrangement. 

What the model doesn’t really discuss is the risk to those outside the model—if you’re not a collaborator, you’re a line-item cost. That’s a different relationship, and PT practices know what that feels like today: pressure on visit counts, duration of care, and preferred providers. Collaborating practices get to sit at the table and negotiate the deal to define what efficient, effective PT in CJR-X looks like, and that’s where physical therapy practices want to be.

What PT Practices Will Hospitals Select?

Not every organization will be, or should be, a good fit for this type of model, but every organization should consider it, regardless of the number of providers it has. The model is mandatory for inpatient and outpatient procedures that aren’t already opted into the TEAM model.

Between CJR-X and TEAM, bundles just became ubiquitous for joint replacement procedures, and that means some types of care you provide today may need to evolve to match in order to stay competitive in your market and attractive to your partners tomorrow. 

If your organization (or your affiliations) has some or all of the attributes below or is working on these now, you are likely a good fit for the model and should consider a plan of action to pursue hospital partners in your area:

Consider CJR-X, particularly if your organization:

1. Sees meaningful numbers of post-surgical TKA/THA/ankle replacement patients (100+ per year).

2. Has existing referral relationships with hospitals or orthopedic surgeons.

3. Has existing data sharing agreements with local hospitals.

4. Has electronic outcomes reporting (KOOS, JR; HOOS, JR; or PROMIS PF).

5. Can deploy and execute a consistent care protocol.

6. Has a system for bidirectional communication with referring organizations.

Why PT Collaboration Is the Key to Success in CJR-X

While orthopedic surgeons are the critical providers in the joint replacement procedure itself, little variance exists in that phase. The things the surgeon controls—the implant, the technique, and decisions during the procedure—are very important, but don’t typically change the cost of the procedure.

Rather, it is the utilization of post-acute care, services, and settings that can make or break the target price. If the patient readmits and needs a week in a skilled nursing facility, that can increase costs rapidly. Identifying and addressing those issues early with appropriate post-acute care is essential.  

Beyond the care PTs provide, they can also perform another essential function within CJR-X: outcomes collection. Orthopedic surgeons often do not have a reliable way to collect the outcome data points needed in CJR-X. PTs who work with outcomes vendors that capture outcomes data electronically will have a big advantage since that data is required for the quality section of the model. It makes the most sense for PT to collect these outcomes since they are the provider who can efficiently address the issue or escalate as needed. 

Remote Therapeutic Monitoring Is Ready for Prime Time

CMS and the American Medical Association have been refining the RTM codes since their creation through the AMA’s CPT editorial process. Since the beginning of this year, PTs have had access to the short-duration version of the RTM codes, allowing for billing after 2 to 15 days of patient data transmission or access (98985), and after 10 minutes of cumulative monitoring time, which included an interactive communication with the patient (98979). 

On their face, these codes are exciting because they make it easier for PTs to bill RTM and expand access to those services for more patients. However, with the release of this new model, we can see CMS’s vision: short-duration monitoring to support patients with all hip, knee, or ankle replacement.

Let’s lay out how patient monitoring can now be used to support CJR-X: 

RTM in the pre-surgical period can flag patients who are non-adherent to their prehab programs. These patients can then be prioritized for additional coaching and post-surgical monitoring to prevent complications. 

The pre-surgical RTM period can also provide additional fee-for-service billing ($100 to $300) outside the bundling period. Providing monitoring, communication, and education to patients who need extra support would also significantly improve the patient experience. Of course, these services would be costly to provide without a care pathway tool that incorporates these elements into the process by default. 

Organizations using a care pathway would also be able to stratify their care and monitoring interventions based on patient need according to predicted adherence issues identified in the pre-surgical phase:

Pre-Surgical Period: RTM for 30 to 90 days according to patient complexity. 

• Identify: Non-adherent patients, patients with high levels of pain, patients with multiple impairments.

Post-Surgical Period: Care pathway with or without monitoring, depending on previous adherence and other clinical flags.

• Short-term (day 0 to 10): Monitor for signs of increasing pain or lack of adherence, which puts the patient at risk for readmissions or joint stiffening.

• Long-term (day 11 to 90): Support complex patients who need more assistance to move through their care plan.

The last piece of the puzzle is the outcomes. By providing monitoring to each patient up front, you’re facilitating the collection of baseline data and communication using a preferred method of contact, as well as connecting several follow-up avenues for the post-surgical outcomes collection at 300 to 425 days after the procedure (SMS, notifications, phone calls, email). 

Many organizations struggle with low collection rates, data loss from paper forms, and a lack of provider compliance. Medbridge is unique in offering flexible options that scale for collecting these electronically, making it a lot easier to get outcomes on all your patients without relying on either your own staff to call patients or outsourced call centers, which increases the costs to the bundle. 

Working with the right vendor for your monitoring and outcomes collection solution is important for streamlining costs and ensuring that the solution is efficient, but the real magic here is how it can facilitate bidirectional communication with your initiator facility, sharing patient milestones and highlighting warning flags that indicate complications. That’s what makes PT collaborators valuable in this model, and RTM is the tool that CMS has been tailoring to this need for years. 

Advice on Getting Started 

Start now! The model takes effect next year and has significant risk. Start collecting outcomes. Start sharing HEPs electronically. Train your staff on RTM. 

And remember, Medbridge is here to help! Request a demo today, and we’ll show you how we’ve combined care pathways, outcomes collection, patient monitoring, and provider education into a uniquely powerful solution for CJR-X.