Get ahead of CJR-X before your peers do
CJR-X will hold most acute care hospitals accountable for the full cost and quality of a 90-day episode following lower joint extremity replacement. Success will take claims and payment policy expertise. DataGen has brought essential analytics to hospitals in bundled payment arrangements since 2012, including:
- baseline opportunity analysis;
- performance data monitoring;
- benchmarking; and
- reconciliation validation.
The value-based care partner since 2012
For years, DataGen has been the trusted analytics partner for at-risk hospitals in bundled payment models, including BPCI, CJR, OCM, BPCIA and TEAM.
The original CJR Model ran for eight performance years. DataGen was there from the first year through the last, supporting 88 at-risk acute care hospitals.
Easier analysis preparation and implementation
Empower your decision-making with critical episodes of care analytics:
- identify cost drivers that create differences in Medicare episode spend across hip, knee and ankle replacement episodes;
- understand utilization and post-acute care patterns over time and in comparison to regional and high-performance benchmarks;
- conduct "what-if" analyses to simulate potential opportunities to create Medicare savings; and
- validate CMS’ reconciliation calculations after the completion of each performance year.
CJR-X model frequently asked questions
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What problem does CJR-XcellenceSM solve under CJR-X?
CJR-X would require most acute care hospitals to manage cost and quality across a 90-day episode for hip, knee and ankle replacement procedures, with Medicare episode spend reconciled against a regional target price. CJR-Xcellence™ gives you visibility into episode risks and opportunities, potential financial exposure and ongoing performance monitoring so you can improve care delivery before results are final.
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What data does CJR-XcellenceSM use?
CJR-XcellenceSM leverages two data sources: your hospital’s CMS episode, claims and target price files (once available under CJR-X); and benchmarks created by DataGen using national Medicare fee-for-service datasets. DataGen applies Medicare’s payment policy rules and the CJR-X specifications for episode-based payment evaluation and reconciliation forecasting.
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How much financial exposure does a hospital face under CJR-X?
Exposure depends on your hospital’s lower extremity joint replacement (LEJR) volume, estimated Medicare episode spend compared to the regional target price, and the quality measures that create the Composite Quality Score. The proposed rule also includes a 5% stop-loss protection for safety net hospitals and a 20% stop-loss protection for all other hospitals, which changes the risk profile materially for qualifying hospitals. The final target price methodology will be published in the federal fiscal year 2027 (IPPS) final rule; however, it is important to note that additional changes can still occur during FFY 2028 rulemaking prior to the model going live on Oct. 1, 2027.
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How is CJR-X different from the original CJR Model?
The basic structure is the same: a 90-day episode, regional target prices and upside or downside payment based on cost and quality performance. The key differences are scope and complexity. CJR-X would apply nationwide to most acute care hospitals instead of hospitals located in a limited set of metropolitan areas. CMS has proposed more sophisticated risk adjustment (29 adjusters compared to three in the original CJR model), an updated quality measurement framework and a 5% stop-loss protection for safety net hospitals.
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Our hospital participated in the original CJR Model. Do we still need analytics?
Experience with the original CJR Model is valuable, but CJR-X is more complex. The expanded risk-adjustment methodology, more recent regional trends and updated quality framework all impact how hospitals are positioned going into CJR-X. Even more importantly, former CJR hospitals that were excluded from the CJR three-year extension have been out of the model for a long time and may not realize how much the healthcare landscape for these episodes has changed. DataGen’s CJR-XcellenceSM combines analytics and policy expertise to fill that gap.
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Can this help us manage post-acute care costs?
Yes. Post-acute care utilization is one of the largest drivers of variation in LEJR episode cost. Our solution provides insight into which post-acute care providers are being used along with important indicators such as episode volume, Medicare spend per episode, length of stay, readmission rates and Medicare Star Ratings.
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Are there benchmarks we can compare performance to?
Yes. DataGen simulates CJR-X episodes of care according to CMS’ specifications for every hospital in the country using national Medicare datasets. Comparative groups include region, academic medical centers, hospitals of similar bed size, top performers and more. Benchmarks help hospitals see what performance is possible and estimate potential savings from changes in care delivery.
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When should we start preparing for CJR-X?
Now. CJR-X has a proposed start date of Oct. 1, 2027, which gives most hospitals roughly 18 months of lead time from the initial proposal. Baseline analysis, internal alignment across finance, quality and care management teams, and early post-acute partnership conversations all take months (not weeks) to put in place. Hospitals that begin early will be materially better positioned before model performance begins.
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How does CJR-Xcellence support cross-functional teams?
CJR-XcellenceSM is built for finance, care management, quality and strategy teams alike, providing a shared, defensible view of episode performance that supports faster, better-aligned decision-making.
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What does implementation take?
CJR-XcellenceSM solutions are deployed via a DataGen-hosted web-based platform. No internal configuration is required. Implementation is streamlined to support CJR-X timelines, with a focus on getting actionable insights in front of teams as quickly as possible.
Contact
Leave your name and email and we’ll be in touch! Reach out to:
- understand your hospital’s potential financial exposure under the proposed CJR-X Model;
- see how your hospital’s historical LEJR episodes inform CJR-X preparation;
- meet our team of healthcare data and policy experts devoted to your success; and
- get on our list for rulemaking updates and analysis.
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