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Lessons Learned From Bundled Payment Programs
William A Jiranek1, Thomas K Fehring, Mark W Pagnano
1Professor, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina.
Instructional Course Lectures
|August 15, 2019
Summary
Bundled payment programs for hip and knee replacements show cost savings across all care phases. Successful programs require infrastructure to manage patients, with quality measures under development.
Area of Science:
- Health economics
- Orthopaedic surgery
- Healthcare policy
Background:
- The Center for Medicare & Medicaid Innovation (CMMI) introduced bundled payment programs to promote value-based healthcare.
- Hip and knee arthroplasty were selected for pilot programs due to defined care episodes and significant Medicare budget impact.
Purpose of the Study:
- To evaluate the clinical outcomes and cost savings of bundled payment programs for hip and knee arthroplasty.
- To inform orthopaedic surgeons about program performance across diverse practice settings.
Main Methods:
- Analysis of cost savings in operating room, hospital stay, and post-acute care periods for arthroplasty procedures.
- Review of clinical results in various healthcare settings (large systems, academic centers, private practices).
Main Results:
- Cost savings were realized in all phases of care for hip and knee arthroplasty within bundled payment models.
- Effective programs established robust infrastructure for patient management throughout the care continuum.
Conclusions:
- Bundled payment programs can achieve cost savings for hip and knee arthroplasty.
- Infrastructure development is crucial for successful implementation and patient management.
- Patient-reported outcomes and quality metrics are evolving to assess program quality.
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