Episode Details

What if your hospital billed $90,000 for your surgery — and no one on the surgical team had any idea what it cost, or whether you were okay after you went home?

That's not a hypothetical. That's the system Scott Middleton walked into at a Boston conference of hospital administrators and orthopedic surgeons — and what he found will change how you understand every hip replacement, every knee surgery, and every nursing home stay on Medicare.

In this episode, Scott unpacks the incoming CJX bundled payment program — the sweeping CMS policy set to take effect January 1, 2028, that will hold hospitals financially accountable for everything that happens to a Medicare surgical patient from 30 days before the OR to 90 days after they go home. And the hidden detail that changes everything: the risk score that determines how much a hospital gets paid is captured 180 days before the surgery even happens.

• Why the 180-day risk score window means proactive patient management isn't just good medicine — it's now a financial imperative
• How orthopedic surgeons will be incentivized to cherry-pick healthy patients and avoid complex ones under the new bundled model
• Why excluding social determinants of health from the risk score formula is a disaster waiting to happen — and who pays for it
• The "studies" hospitals are using to eliminate physical therapy after hip and knee surgery — and why they're comparing apples to 88-year-olds
• How Your Health is already positioning itself as the value-based care partner that orthopedic surgeons and hospitals are going to desperately need

The system that's coming will reward the organizations that have been doing the right thing all along — and penalize everyone who's been gaming fee-for-service. Press play to find out which side you're on.

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