Rainfall Health Applauds CMS on Latest Innovative Push Toward Universal Episode-Based Payment Models

CJR-X final rule represents a new era of value-based care at a national scale, holding all acute-care hospitals accountable for care related to joint replacements, with bold moves away from fee-for-service.

SAN FRANCISCO, July 31, 2026 /PRNewswire/ -- Today, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year 2027 Inpatient Prospective Payment System (IPPS) final rule. Within this 1,500+ page annual rule, the Comprehensive Care for Joint Replacement Expansion (CJR-X) was codified – signifying the country's firm transition to value-based payment models. Building off of the CMS's codification of the Transforming Episode Accountability Model (TEAM) last July, this move will catalyze the nationalization of episode-based payment models for surgical care, setting up the framework for other payers to follow.

CJR-X is the CMS Innovation Center's (CMMI) first expanded model implemented by the Trump Administration. Further, it is one of only a few models that have even met expansion criteria in the greater initiatives around reducing waste in healthcare by managing care across the post-acute setting. This is largely due to the success of CJR, which produced $112.7 million in savings to Medicare in the last two years and ran from April 2016 to December 2024. Its successor, CJR-X, will now launch January 1, 2028, impacting nearly all US acute care hospitals through the 90-day episode of care post-discharge.

CMS projects CJR-X will generate $725 million in net Medicare savings across its first five performance years, building on the original CJR model's track record in net Medicare savings while maintaining quality for over 98,000 knee and hip replacement patients across 323 hospitals.

"Today's news signifies that value-based surgical care is now the permanent direction of our healthcare system and an important frontier for AI leadership for the country," said Eddie Qureshi, CEO and Founder of Rainfall Health. "While CJR-X is a small part of the larger IPPS rule, the impacts are transformational. CMS is requiring hospitals to hold themselves accountable in the new value-based era, giving them an unprecedented opportunity to invest in care coordination infrastructure, episode analytics, and post-acute partnerships."

Rainfall Health was created specifically for these value-based CMS payment models, providing an AI platform that is built to help hospitals comply with federal mandates like TEAM and CJR-X. The platform utilizes AI's advanced processing to collect, standardize, and report on patient outcomes so that hospitals can properly track patients and keep them connected with their provider.

"CMS is demonstrating a renewed commitment to value-based care – representing a new era of surgical care models," said David Shulkin M.D., the Ninth Secretary of the US Department of Veterans Affairs and Chair of the RAIN Advisory Committee. "Though it was CJR-X codified today, impacting lower extremity joint replacements, a natural next step is to broaden the model to the other surgical procedures covered in TEAM – including CABG or spinal fusion. Providers are finding AI solutions that help them remain accountable to these new mandates."

Hospitals nationwide will face significant financial penalties if they are unable to deliver on the requirements listed in CJR-X. However, Rainfall Health sees additional compliance rules as a clear opportunity to invest in a new standard of care and access for their patients, bringing in technology advancements and a strengthened relationship with post-acute care partners.

To learn more about Rainfall and its offerings for hospitals impacted by CJR-X and TEAM, visit the website here.

About Rainfall Health:
Rainfall Health is an AI-driven compliance and reimbursement platform helping hospitals and medical groups navigate new federal mandates such as CMS's TEAM model and CJR-X. The company is shaping a new national standard for mandated care model compliance through the RAIN Compliant™ designation which is a verifiable, AI-enabled framework adopted by hospitals, payers, and clinical partners. Rainfall works with health system executives, physician groups, and post-acute partners to automate complex regulatory requirements, improve care-quality performance, and unlock new Medicare revenue streams. Follow Rainfall Health on LinkedIn and Twitter.

SOURCE Rainfall Health