Brookfield, Conn. – November 03, 2026 -- Medicare's CJR-X model will place 2,217 hospitals under mandatory two-sided financial risk on January 1, 2028. CMS's final rule projects those hospitals will repay $1.855 billion over five years while receiving $1.463 billion.

The model makes hospitals responsible for the full cost of hip, knee and ankle replacements through 90 days after discharge. Hospitals that beat a regional target price earn a bonus, while those that miss it pay Medicare back.

CMS projects a net $392 million transfer from hospitals to Medicare

The repayment gap leaves a net $392 million flowing to Medicare. More than half of the projected $736 million in savings comes from pricing alone.

Predecessor CJR left 60% of participating hospitals owing money in 2023

The earlier CJR program shows the direction of travel:

• 60% of participating hospitals owed Medicare money in 2023, a record.
• Safety-net hospitals were 27 of the 32 largest repayers.
• CJR's elective target price fell 14.4%, to $20,794 from $24,287.

Healthier patients are also shifting to surgery centers outside CJR-X, leaving hospitals with the costlier cases.

More than 40% of episode spending occurs after discharge

ROMTech, a home-based rehabilitation vendor, advises hospitals to take four steps before 2028:

• Benchmark 2024-2026 spending against the regional average.
• Cut avoidable rehab facility stays and readmissions.
• Protect the quality score, which sets discount and bonus eligibility.
• Use the waivers for home visits and telehealth.

ROMTech pitches AI-guided home rehabilitation to cut post-discharge costs

ROMTech's PortableConnect system delivers supervised at-home rehabilitation after joint replacement. The company says its platform draws on more than 25 billion data points from more than 12 million therapy sessions, which it describes as 1,000 times more patient data than legacy rehab.

ROMTech reports that its AI predicts key outcome measures with 94% accuracy by Day 5 and 98.9% by Day 10. It also claims readmissions fall by up to 88%. Treatment plans update with each session's data; the AI recommends and the clinician decides.

"Ultra-dense data reveals what no human eye can see," said Peter Arn, CEO of ROMTech.

Newsweek named ROMTech one of 10 winners worldwide of its 2026 AI Impact Health Awards. Judges included leaders from Memorial Sloan Kettering, Hospital for Special Surgery and Mount Sinai.

ROMTech models $720,000 in annual savings for a 300-episode hospital

For a hospital with 300 episodes a year at a $20,794 target, running 5% over costs about $312,000. At ROMTech's stated average savings of $2,400 per episode, the same hospital would save about $720,000 a year.