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Prometheus payment model: application to hip and knee replacement surgery.

Amita Rastogi1, Beth A Mohr, Jeffery O Williams

  • 1Prometheus Payment, Bridges to Excellence, Munster, IN 46321, USA. amita.rastogi@bridgestoexcellence.org

Clinical Orthopaedics and Related Research
|June 24, 2009
PubMed
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The Prometheus Payment Model uses evidence-informed case rates (ECRs) to improve healthcare payments. This model focuses on reducing potentially avoidable complications (PACs), turning waste into savings for providers.

Area of Science:

  • Health Economics
  • Healthcare Payment Models
  • Medical Quality Improvement

Background:

  • Current fee-for-service and capitation models have significant failings.
  • Healthcare costs are rising, with a substantial portion attributed to complications.
  • Need for innovative payment systems that incentivize quality and efficiency.

Purpose of the Study:

  • To evaluate the Prometheus Payment Model, focusing on evidence-informed case rates (ECRs).
  • To analyze the impact of potentially avoidable complications (PACs) on hip and knee arthroplasty costs.
  • To demonstrate how accountability for PACs can drive cost savings.

Main Methods:

  • Development of ECRs based on evidence, expert opinion, and data analysis.
  • Inclusion of patient severity, PACs, and provider cost variations in the model.

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  • Analysis of PAC costs in hip and knee arthroplasty cases.

    • Main Results:

    • Potentially avoidable complications (PACs) represented 14% of total costs in hip and knee arthroplasty.
    • For hip arthroplasty, PAC costs were $7.8 million (n=699 PAC stays).
    • For knee arthroplasty, PAC costs were $12.7 million (n=897 PAC stays).

    Conclusions:

    • The Prometheus model incentivizes providers to reduce PACs by assigning clinical and financial responsibility.
    • Quantifying and segmenting PACs makes the data actionable for providers.
    • Focusing on PAC reduction offers a pathway to transform waste into potential cost savings.