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Summary

Bundled payments for total joint arthroplasty (TJA) aim to control costs and enhance care quality. This review examines orthopedic groups implementing TJA bundled payment models with public and private insurers, discussing potential challenges and advantages.

Keywords:
BPCIBundle paymentsBundled contractsComprehensive care for joint replacementPrivate payersTotal joint arthroplastyTotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Healthcare Economics
  • Health Policy

Background:

  • Centers for Medicare and Medicaid Services (CMS) introduced bundled reimbursement for total joint arthroplasty (TJA) to manage costs and improve care.
  • Private insurers are adopting similar bundled payment models for TJA in collaboration with healthcare providers.

Purpose of the Study:

  • To review the experiences of orthopedic groups in implementing bundled payments for TJA.
  • To discuss the potential benefits, risks, and barriers associated with bundled payment models for primary and revision TJA.

Main Methods:

  • Review of implementation experiences of orthopedic groups.
  • Analysis of bundled payment models from both public (CMS) and private payers.
  • Discussion of potential benefits, risks, and barriers.

Main Results:

  • Orthopedic groups are actively engaging with bundled payment models for TJA.
  • Both public and private payers are utilizing bundled payment strategies for TJA procedures.
  • Implementation involves navigating various benefits, risks, and barriers.

Conclusions:

  • Bundled payment models for TJA are increasingly adopted by public and private payers.
  • Understanding the experiences, benefits, risks, and barriers is crucial for successful implementation by orthopedic groups.
  • This payment model represents a significant shift in TJA reimbursement and care delivery.