Bundled Payment Arrangements: Keys to Success

Area of Science:

• Health Policy
• Orthopaedic Surgery
• Healthcare Economics

Background:

• The Centers for Medicare & Medicaid Services (CMS) aims to shift 50% of fee-for-service care to value-based payment models.
• Bundled payment arrangements are central to this healthcare reform initiative.
• The Comprehensive Care for Joint Replacement (CJR) model is a key mandatory program.

Purpose of the Study:

• To inform orthopaedic surgeons about the Comprehensive Care for Joint Replacement (CJR) model.
• To highlight the importance of understanding bundled payment principles for successful participation.
• To outline the structure and scope of the CJR program.

Main Methods:

• The CJR model bundles lower extremity joint arthroplasties into defined episodes of care.
• These episodes encompass the index admission and extend 90 days post-discharge.
• The program commenced on April 1, 2016, involving numerous hospitals performing total joint arthroplasties.

Main Results:

• The CJR model represents a significant shift from traditional fee-for-service reimbursement.
• It integrates care across multiple providers within a defined episode.
• Participation is mandatory for many hospitals undertaking total joint replacements.

Conclusions:

• Orthopaedic surgeons must understand the seven core principles of the CJR model.
• Familiarity with these principles is crucial for maximizing participation and success in the program.
• The CJR model signifies a move towards value-based care in orthopaedic surgery.