The device isn't the product anymore. The procedure is.
Value-based accountability in orthopedics is no longer voluntary — it's federal policy. MSKvalue lays out the accountable episode: plan the surgery, measure the outcome, document what happened. No capital robot required. No implant lock-in.
Are you in scope? Check in 60 seconds →Today: the self-check runs in your browser and sends nothing. Next: the exact answer for a hospital or an NPI, on CMS’s own files, at SurgeonValue.
The three mandatory CMS models that score the MSK episode, by start date.
The buyer of surgical technology isn't a procurement manager with a CapEx budget anymore. It's the ASC operator watching procedure volume, the service-line leader tracking cost per case, and the CFO measuring reimbursement and ROI. So the evaluation metrics change:
| Stop evaluating on | Start evaluating on |
|---|---|
| Features | Cost per procedure |
| Specifications | Utilisation rate |
| Price per unit | Revenue per operating-room hour |
| The capital committee | Clinical outcomes, measured |
CMS has said the quiet part out loud: voluntary models let organizations opt in only when they can win. So the newest models are compulsory — and orthopedics is the tip of the spear.
Mandatory joint-replacement bundle since January 2026, at hospitals in selected regions. Hip & knee episodes scored on cost, complications, readmissions, and patient-reported outcomes through 30 days post-discharge. What an administrator does now →
Mandatory, no opt-out. The low-back cohort pulls orthopedic, spine, neurosurgery, and pain clinicians into peer benchmarking — with −9% to +9% of Part B riding on each individual clinician's cost-and-quality score, applied from payment year 2029. The ASM math →
Finalized July 31, 2026 (CMS-1849-F): mandatory joint-replacement bundles for most IPPS hospitals nationwide (TEAM participants, Maryland, and hospitals not paid under both IPPS and OPPS excepted). Hip, knee, and — newly — ankle, with 90-day episode accountability on total Part A+B spending and quality. The first expanded mandatory episode model in Medicare history. The model page at CMS →
We’re building a way for a surgeon to review a flagged recovery reading on a phone and record the decision in one step. In development; nothing here bills on its own.
A joint replacement's cost isn't one number; it's four levers. Here is each one, and what documenting it per case involves.
Where the case is done changes the facility cost of the episode. Captured per case, so any difference is shown on your own cases rather than asserted.
The implant is one of the largest single lines in a joint replacement. Standardizing to the construct the case actually needs, negotiated on cost rather than the rep’s catalog, attacks that line directly — without locking the facility to one manufacturer’s system. This is the metric that moves the story.
Revisions cost more than the primary, and infected revisions far more. Whether personalized alignment lowers revision risk is still being studied; most revisions happen years later, outside the 30- and 90-day episode windows.
Recovery tracked at home through the 30-day window CMS scores. JointCoach runs the exercise tracking on the patient’s phone today; the clinic-side review record is a 90-day pilot, not a finished tool. Whether it changes readmissions is what the record would have to show.
arthritisrisk.com and jointclass.com publish independent patient education on joint health and what the evidence supports. They name no surgeon, no facility and no product, and nothing they publish depends on where a patient goes next.
Standard implants and mechanical alignment force every patient's joint into a narrow set of shapes. Real anatomy doesn't work that way. Here is the case for personalization, made plainly.
No two knees, hips, or shoulders are the same. A plan and implant matched to the individual restores their own anatomy instead of averaging it away.
A share of patients remain dissatisfied after knee replacement (estimates vary widely with the definition used), and alignment and fit are among the suspected reasons. Personalization is aimed at that problem.
Better fit is aimed at lower revision risk. Revisions cost more than the primary, but most happen years after surgery, outside the 30- and 90-day episode windows, so they show up in a center's long-run costs rather than in a single episode.
Why your revision rate is your P&L →Implant-agnostic planning, delivered as software rather than steel, so a facility is not tied to one manufacturer’s system.
Honest framing: the high-level trial evidence on personalization is still maturing — which is exactly why the design instruments each case for registry reporting. The argument today is mechanistic, value-aligned, and patient-centered; the confirmatory data is what we build.
Component malposition drives revision, and the literature is consistent on it: glenoid and component placement accuracy is tied to clinical and radiographic outcome (Gregory, PLoS One 2013), and poor position is a recurring feature of unsatisfactory and revised arthroplasty (Franta, JSES 2007; Duethman, JSES Int 2020). In the shoulders that failed and required revision, most components were found malpositioned (Sperling, JSES 2025).
The honest boundary — and it is the point: that last figure is the rate among revisions, not the rate across all replacements. We say it precisely because vendors quote the revision number as if it were the general incidence. The defensible claim is narrower and stronger: position affects outcome, malposition drives the costly revisions the mandatory models now measure, and a plan built to the patient’s anatomy is the lever — on any implant, not one manufacturer’s.
Under TEAM, ASM, and now CJR-X, you are accountable for the whole episode — and paid on what you can document. Here is the record a value-based MSK program has to produce, stage by stage, on any implant and inside any surgeon’s workflow.
The prior-authorization trail and a functional baseline (PROMs, gait) that establish the patient genuinely needed surgery — the record payers and the mandate both require.
Whatever construct and alignment the surgeon chooses, the decision and its rationale are captured — a named clinician’s judgment, documented, never overwritten by a tool.
The two biggest episode levers — surgery-center versus hospital, and implant cost — captured per case, so the savings are provable rather than asserted.
PROMs and remote monitoring across the 30–90 day window CMS scores. RTM can be billed only by a clinician outside the surgeon's global period, never by the surgeon inside it.
Cases reported to the American Joint Replacement Registry, the national benchmark. Automated abstraction for it is in design at SurgeonValue.
Cost, complications, and outcomes documented end to end — the record a mandatory episode is scored on.
Measure, don’t promise. A promised outcome is marketing. A measured error is evidence. A tool that says it improves the episode should be scored against two yardsticks, the guideline and the treating surgeon, with both reported and never averaged, and a correct decision not to operate should score the same as a correct decision to operate. Drafting is allowed. Judgment needs a name. MSKvalue never uses outcomes to rank surgeons or sites, and makes no per-clinician outcome claim below 40 episodes, the floor used in risk-adjusted benchmarking of physical therapists (Lutz, Physical Therapy 2020). The scoring rules are open: orthoharness (Apache-2.0) is a reference implementation, not a validated benchmark; its demo cases are synthetic and its weights are placeholders. The harness, explained →
MSKvalue doesn't reinvent the wheel; it integrates the best product at each stage of the joint-care episode into a single, measured, reimbursable arc.
An on-device check, with no account, that helps a person tell mechanical from inflammatory joint pain before they see anyone. arthritisrisk →
Evidence-based pre-op and post-op education that scales the "best-in-class" patient experience. JointClass →
The surgeon’s construct and alignment choice captured per case — implant-agnostic, so the decision and its cost are provable on any system. Which knees positioning alone will balance is predictable before the case.
Outcomes benchmarked against the American Joint Replacement Registry — 4.6M procedures, the national standard. Case-by-case registry abstraction is in design. AJRR →
The surgeon-side practice tools: coding and prior-authorization drafts the surgeon reviews and signs. RTM and AJRR abstraction are in design, not working tools yet. SurgeonValue →
Camera-based exercise tracking that runs on the patient’s phone, with a record the clinician reads at the visit. The clinic-side RTM review is a 90-day pilot. JointCoach →
The path to a better joint now begins online — a symptom search, a short risk check, a night of reading — long before a patient ever chooses a surgeon. A patient who arrives at that consult already understanding what personalization is, and what the evidence supports, asks better questions and makes a more informed decision. These sites educate; they never route.
Knee or hip pain sends them online. A short joint check, kept on their device, meets them there.
Plain-language education shows a plan built for their body is possible.
Independent education helps them understand the options and see which nearby surgeons offer personalized planning — they choose and contact directly. No routing, no introductions.
The patient reaches the consult already understanding the personalized option.
Under the CMS ACCESS Model (musculoskeletal track, live July 2026), managing chronic MSK pain is itself reimbursed, so the whole screened population is cared for, not filtered for the few who reach the OR.
ACCESS pays outcome-aligned, and referring clinicians bill a separate Co-Management Payment — HCPCS G0677 for the MSK track, paid per service (plus a one-time Modifier AC add-on if you assist with set-up), up to three times per 12-month care period per patient per track. No model enrollment is required to bill it — any eligible Part B practitioner can. Patients who don’t need surgery are still a reimbursed relationship. MSK outcomes are scored on PROMIS PF, PROMIS PI and PGIC.
CMS Innovation Center →The 150+ accepted ACCESS organizations already serve attributed Medicare panels. Offering those patients independent MSK education and a short risk check (arthritisrisk.com) is care delivered inside a relationship that already exists — not cold Google and Meta spend, and not a referral to anyone in particular.
arthritisrisk →A minority of people screened will need surgery, and they arrive at that consult understanding what the options are and what the evidence supports. We measure whether the education worked, not where anyone went.
Where patients get stuck →Figures illustrative and directional; ACCESS payment is outcome-aligned and structure-dependent. These sites educate and screen — they do not refer patients to any specific surgeon, facility, or product. Any arrangement that touches referrals is structured with counsel (AKS/FMV). Not legal or financial advice.
You're now accountable for cost, complications, and outcomes on every joint-replacement episode. MSKvalue is the operating system that lets you land on the right side of the peer curve.
A better joint replacement isn't a bigger hospital. It's a plan built for your anatomy, a team that measures how you actually recover, and care that stays with you from the first ache to full function.
A check on your joint health, kept on your device.
Know what to expect, before & after.
A plan built for your anatomy.
Guided recovery, tracked at home.
Under mandatory two-sided risk, the accountable provider is scored on the whole episode. The numbers that frame it:
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