Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality

Short-term functional recovery after total joint arthroplasty is unaffected by bundled payment participation

“…Although the BPCI aims at increasing value specifically for a subset of Medicare beneficiaries, we enhanced care pathways for all patients undergoing TJA even before our BPCI enrollment. These efforts, described in full elsewhere [13] , [15] , [19] , resulted in decreased hospital LOS, decreased PAC facility use, and reductions in 30-day and 90-day readmission or reoperation, consistent with findings from other organizations [7] , [8] , [9] , [10] , [11] , [12] . These are important outcomes to the value equation as they indicate improved—or maintained—patient outcomes and likely decreases in costs.…”

“…Studies have reported successful cost-containment thus far from bundling payment for TJA. Specifically, costs have been reduced using strategies such as standardization of surgical implants and processes [7] , reduction of postoperative hospital length of stay (LOS) [7] , [8] , [9] , [10] , [11] , [12] , [13] , and decreased use of postacute care (PAC) services [7] , [9] , [14] , [15] in skilled nursing and inpatient rehabilitation facilities. Importantly, it has also been shown that there is no change in unplanned readmission, emergency department use, or mortality in the presence of bundled payment for TJA [9] .…”

Are current DRG-based bundled payment models for lumbar fusions risk-adjusting adequately? An analysis of Medicare beneficiaries

“…First introduced in the 1990s, as part of the inpatient prospective payment system (IPPS), DRGs were intended to allow hospitals to increase efficiency and transparency of care, while reducing costs, through the principle of combining related procedures/cases that are meant to have similar clinical evolutions under one broad inpatient reimbursement code [14−16]. These DRGs are being increasingly used by bundled payment models, such as the BPCI and the comprehensive joint replacement model [17], as a means of identifying/triggering an episode-of-care and constructing stipulated 90-day target episode prices based on historical costs. The results from our study suggest that the current proposed DRG-based bundled payment model is generally inadequate for risk-adjusting prices, as these DRGs are not innately built to cater to the large heterogeneity, varying presentation and/or altering procedure complexity seen within different cases of lumbar fusions.…”

Quality Changes after Implementation of an Episode of Care Model with Strict Criteria for Physical Therapy in Ontario's Long‐Term Care Homes

“…BPCI initiatives have demonstrated reduced health care costs(Dummit et al. ; McLawhorn and Buller ; Siddiqi et al. ) and improved quality outcomes such as decreased length of stay (Iorio et al.…”