Reducing Orthopedic Readmissions: 5 Proven Strategies for CMS Bundle Success in 2025
- SolvEdge
- Dec 18, 2025
- 5 mins read
Hospital readmissions remain one of the biggest financial and clinical burdens in U.S. healthcare—costing systems more than $52 billion annually. In FY2025, CMS’s Hospital Readmissions Reduction Program (HRRP) penalized over 7% of facilities, while orthopedic bundles like the Comprehensive Care for Joint Replacement (CJR) model continue to spotlight joint replacement readmissions. National rates hover at 14.9% for elective hip and knee procedures, putting mid-sized programs—many performing 2,500–3,000 inpatient surgeries yearly—directly in the crosshairs.
For community hospitals like MidState Medical Center (156 beds, Leapfrog “A” safety grade), success isn’t optional. It’s survival. The good news? Leading systems are achieving 30%+ reductions in orthopedic readmission reduction 2025 through smarter, connected workflows. Here are the 5 proven strategies driving CMS CJR strategies and bundle success today.
Strategy 1: Predictive Risk Stratification at Discharge
The most preventable readmissions start with the patients you can identify before they leave.
Integrate clinical data (comorbidities, BMI, prior utilization) with social determinants (transportation barriers, home support) into a real-time risk engine. Prisma Health’s 3-tier model—flagging low, moderate, and high-risk patients at discharge—delivered 20–30% fewer returns by triggering intensified navigation for the top tier.
Hospital discharge optimization begins with knowing who needs more than a pamphlet.
Strategy 2: Automated Post-Discharge Engagement
Manual phone calls reach only 30–50% of patients. Automated, omnichannel outreach changes the game.
SMS check-ins, interactive voice response, and app-based teach-back modules ensure patients understand wound care, weight-bearing restrictions, and warning signs. A 2024 Journal of Patient Safety study showed automated engagement cut orthopedic readmissions by up to 45% in the first 30 days.
This is post-surgical patient monitoring that scales without burning out nursing staff.
Strategy 3: Seamless Care Transitions and Medication Reconciliation
Up to 75% of preventable readmissions stem from medication errors or missed follow-up appointments.
Embed digital reconciliation tools into discharge workflows:
Auto-compare pre-admission and discharge meds.
Send pharmacist-reviewed lists directly to patient phones.
Schedule orthopedic follow-ups before the patient leaves the floor.
Facilities using these closed-loop processes report significant drops in 90-day returns—critical for CMS CJR strategies.
Strategy 4: Remote Monitoring Tailored to Ortho Recovery
Joint replacement patients don’t fail in the hospital—they fail at home when pain spikes, mobility stalls, or incisions deteriorate unnoticed.
Remote monitoring for ortho recovery delivers:
Daily PROMs (KOOS Jr., HOOS Jr.) via text or app.
Wearable-synced step counts and range-of-motion trends.
AI-flagged alerts for swelling, drainage, or non-adherence.
One regional system reduced post-knee and shoulder procedure complications by 38% simply by intervening on Day 4 instead of Day 14.
Strategy 5: Data-Driven Reporting Aligned to CMS Requirements
You can’t improve what you don’t measure consistently.
Build dashboards that pull EHR, claims, and patient-reported data into CMS-aligned FRO (Functional Recovery Outcome) benchmarks. Track surgeon-level variation, bundle performance, and penalty risk in real time.
MidState-like facilities using this approach not only avoid HRRP hits—they turn outcomes data into service-line growth.
The 30% Reduction Blueprint
| Strategy | Typical Impact | Key Enabler |
|---|---|---|
| Predictive Stratification | 20–30% fewer high-risk returns | Integrated risk scoring |
| Automated Engagement | Up to 45% reduction | Omnichannel outreach |
| Seamless Transitions | Addresses 75% preventable causes | Digital med rec |
| Remote Ortho Monitoring | 38% complication drop | Daily PROMs + wearables |
| Data-Driven Reporting | Full CMS compliance + ROI proof | Unified analytics |
Start Your Orthopedic Readmission Reduction Journey Today
Community hospitals proving bundle success in 2025 aren’t adding headcount—they’re connecting workflows that already exist.
Turn Better Outcomes Into Your Competitive Edge
Optimize joint replacement discharge and reduce readmissions.
