The federal government’s proposed expansion of a major joint replacement payment model could open the door for certified registered nurse anesthetists to qualify for better Medicare reimbursement.
Under the proposed FY 2027 Inpatient Prospective Payment System rule, CMS would expand the Comprehensive Care for Joint Replacement model into a nationwide program dubbed CJR-X. The American Association of Nurse Anesthesiology is urging CMS to confirm that CRNAs and CRNA group practices would qualify as alternative payment model participants.
Under MACRA’s payment structure, clinicians who are qualifying participants through the Advanced Alternative Payment Models receive higher Medicare Part B payment incentives than those who don’t. For CRNAs, who have seen consistent cuts to the anesthesia conversion factor in recent years, including a 2.83% reduction in 2025, access to APM pathways is increasingly important to maintaining sustainable reimbursement.
AANA notes that CJR-X participants would submit information on eligible clinicians who enter into financial arrangements with them, which would enable CMS to make qualifying participant determinations. AANA interprets this to mean CRNAs functioning as CJR-X collaborators could achieve QP status, assuming the CJR-X participant meets the required certified electronic health record technology criteria.
CJR-X is structured around episode-based payments for lower-extremity joint replacements, an area where ASC volume has grown significantly. CRNAs would be included as “collaborators” — entities that enter into sharing arrangements with the CJR-X participant hospital — and would be eligible for gainsharing payments tied to cost and quality performance.
Notably, CMS has proposed prohibiting CJR-X participants from charging collaborators a fee to be included on a preferred provider list. AANA said this prohibition was important for ensuring CRNAs can participate without facing pay-to-play barriers.
AANA is pushing back on one element of the proposal: a requirement that every CJR-X collaborator provide written notice to each beneficiary they treat, disclosing the existence of their sharing arrangement. AANA argues this creates unnecessary administrative burden and is particularly impractical for anesthesia providers given the nature of when and how anesthesia services are delivered. The organization recommends CMS instead build a web-based portal where beneficiaries can look up collaborators by hospital.