Lessons Learned From Bundled Payment Programs

To encourage the shift to value-based health care, the Center for Medicare & Medicaid Innovation created bundled payment programs in which episodes of care are paid for in a bundled fashion. Hip arthroplasty and knee arthroplasty were believed to be good procedures to pilot in bundled payment programs because these procedures had an easily defined episode of care and accounted for a considerable amount of the Medicare budget. Cost savings for hip and knee arthroplasty in bundled payment programs can be divided into cost savings achieved in the operating room, in the hospital, and in the postacute care period. Orthopaedic surgeons should be aware of the clinical results of hip and knee arthroplasty in bundled payment programs in various practice settings, including large healthcare systems, large academic centers, and private practices. Cost savings have been achieved in all phases of hip and knee arthroplasty in bundled payment programs. Almost all successful practice settings have developed an infrastructure to organize, administer, and manage patients through the different phases of patient care in bundled payment programs. Patient-reported outcomes and quality measures are being developed to determine the quality of the services provided in bundled payment programs.