Early Results of Medicare's Bundled Payment Initiative for a 90-Day Total Joint Arthroplasty Episode of Care

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

“…Coordinating care among providers resulted in an 18% reduction in average LOS and a shift from home health and skilled facility discharge to home self-care (54.1 to 63.7%), which resulted in a 6% reduction in cost over the study period. Similarly, in 2016 another large academic institution reported its results after implementing hospital wide changes following the adoption of a bundled payment model [67]. The authors reported a decrease in the average hospital LOS from 4.27 to 3.58 days and discharges to skilled care facilities decreased from 71 to 44%.…”

Are Bundled Payments a Viable Reimbursement Model for Revision Total Joint Arthroplasty?

“…Several studies have shown the effectiveness of bundledpayment models for primary hip and knee arthroplasties [3,8,10]. However, revision TJA presents a complex set of problems for bundling episode-of-care payments.…”

“…The Centers for Medicare & Medicaid Services (CMS) rolled out the Bundled Payment for Care Improvement (BPCI) initiative in 2011 to align incentives among healthcare stakeholders to reduce the cost to Medicare for joint replacements [5]. Although bundled payments for primary joint arthroplasty have been shown to be a feasible alternative to traditional fee-for-service payments [3,8,10], it has yet to be determined if bundled payments are appropriate for revision TJA.…”

Value-based Healthcare: Part 1—Designing and Implementing Integrated Practice Units for the Management of Musculoskeletal Disease

“…Further advantages of IPUs include offering more integrated care, engaging patients virtually, addressing modifiable risk factors, and better performance in procedure-based bundled-payment programs. The latter is accomplished via preoperative risk factor modification, which will yield higher rates of patients discharged to their homes, fewer unplanned readmissions, and fewer reoperations [2]. Lastly, orthopaedic practices that consistently measure and demonstrate better value will be best-positioned to contract with employers and payers for quality designation programs with various levels of risk-sharing.…”

“…Some questions we need to consider: (1) What are the principles for designing a musculoskeletal IPU? (2) What are the potential benefits of this strategy in the fee-for-service environment? (3) How can orthopaedic surgeons prepare for value-based payment?…”