The Joint Utilization Management Program-Implementation of a Bundle Payment Model and Comparison Between Year 1 and 2...

Area of Science:

• Health Economics
• Healthcare Management
• Orthopedic Surgery Outcomes

Background:

• Rising healthcare expenditures and total joint arthroplasties (TJAs) necessitate cost-containment strategies.
• Bundled Payments for Care Improvement (BPCI) offers a promising reimbursement model to manage costs.
• Focus on the post-acute care (PAC) phase is crucial for economic efficiency in TJA.

Purpose of the Study:

• To evaluate the outcomes of the Joint Utilization Management Program (JUMP) within the BPCI framework.
• To compare the efficiency of PAC services in the first two years of the JUMP model implementation.
• To assess the impact of the JUMP model on length of stay and readmission rates.

Main Methods:

• Implementation of the Joint Utilization Management Program (JUMP) in January 2014.
• Inclusion of Medicare patients undergoing primary unilateral inpatient TJAs, outpatient procedures with admission, and trauma-related TJAs.
• Utilized scorecards to monitor surgeon performance and PAC length of stay (LOS), guiding gain-sharing allocations.

Main Results:

• Post-acute care (PAC) utilization decreased from 2014 to 2015.
• Average PAC length of stay (LOS) significantly reduced from 4.50 days in Year 1 to 3.19 days in Year 2.
• Inpatient rehabilitation (IPR) rates decreased by 48% with a 1.47-day reduction in average IPR LOS.
• 30-day readmission rates declined from 10.56% to 8.77%, with earlier readmissions observed in Year 1.

Conclusions:

• The JUMP model, under the BPCI program, enhanced PAC efficiency.
• Demonstrated significant reductions in PAC length of stay (LOS) and inpatient rehabilitation (IPR) admission rates.
• Achieved a lower 30-day readmission rate, indicating improved patient outcomes and care coordination.