On the morning of April 1, hospital and medical device company executives woke up to yet another new chapter in bundled pricing — CMS’ Comprehensive Care for Joint Replacement (CJR) initiative. Unlike the Bundled Payments for Care Improvement (BPCI) programs that preceded it, there is no opt-out clause for the 800 hospitals designated as participants across the U.S.

The implementation of CJR signals CMS’s intent to ramp up pressure for progress toward value-based reimbursement. Making hospitals accountable for cost and quality for complete care episodes represents a stepping stone toward broader accountability.