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Lessons Learned From Bundled Payment Programs.

William A Jiranek1, Thomas K Fehring, Mark W Pagnano

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|August 15, 2019
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Summary
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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.

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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.