Standardizing Care and Improving Quality under a Bundled Payment Initiative for Total Joint Arthroplasty

Froemke, Cecily; Wang, Lian; DeHart, Matthew L.; Williamson, Ronda K.; Ko, Laura Matsen; Duwelius, Paul J.

doi:10.1016/j.arth.2015.04.028

Cited by 86 publications

(37 citation statements)

References 13 publications

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“…Several studies have shown the effectiveness of bundledpayment models for primary hip and knee arthroplasties [3,8,10]. However, revision TJA presents a complex set of problems for bundling episode-of-care payments.…”

Section: Discussionmentioning

confidence: 99%

“…The Centers for Medicare & Medicaid Services (CMS) rolled out the Bundled Payment for Care Improvement (BPCI) initiative in 2011 to align incentives among healthcare stakeholders to reduce the cost to Medicare for joint replacements [5]. Although bundled payments for primary joint arthroplasty have been shown to be a feasible alternative to traditional fee-for-service payments [3,8,10], it has yet to be determined if bundled payments are appropriate for revision TJA.…”

Section: Introductionmentioning

confidence: 99%

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Are Bundled Payments a Viable Reimbursement Model for Revision Total Joint Arthroplasty?

Courtney

Ashley

Hume

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Alternative payment models, such as the Centers for Medicare & Medicaid Services (CMS) Bundled Payment for Care Improvement (BPCI) initiative, aim to decrease overall costs for hip and knee arthroplasties. Questions/purposes We asked: (1) Is there any difference in the CMS episode-of-care costs, hospital length of stay, and readmission rate from before and after implementation of our bundled-payment program? (2) Is there any difference in reimbursements and resource utilization between revision THA and TKA at our institution? (3) Are there any independent risk factors for patients with high costs who may not be appropriate for a bundled-payment system for revision total joint arthroplasty (TJA)? Methods Between October 2013 and March 2015, 218 patients underwent revision TKA or THA in one health system. Two hundred seventeen patients were reviewed as part of this study, and one patient with hemophilia was excluded from the analysis as an outlier. Our institution began a BPCI program for revision TJA during this study period. Patients' procedures done before January 1, 2014 at one hospital and January 1, 2015 at another hospital were not included in the bundled-care arrangement (70 revision TKAs and 56 revision THAs), whereas 50 revision TKAs and 41 revision THAs were performed under the BPCI initiative. Patient demographics, medical comorbidities, episode-of-care reimbursement data derived directly from CMS, length of stay, and readmission proportions were compared between the bundled and nonbundled groups. Results Length of stay in the group that underwent surgery before the bundled-care arrangement was longer than for patients whose procedures were done under the BPCI (mean 4.02 [SD, 3.0

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Are Bundled Payments a Viable Reimbursement Model for Revision Total Joint Arthroplasty?

Courtney

Ashley

Hume

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…They called for closer monitoring of quality metrics and surgical outcomes to ensure that a uniform standard of care is being delivered. With a transition towards bundled payment, Medicare has put increasing demand on Orthopedic joint replacement surgeons to define and meet quality metrics 32‐34 . With the implementation of a comprehensive risk modification and patient education program, Dundon et al found that they were able to decrease LOS, decrease readmissions and decrease costs of care.…”

Section: Discussionmentioning

confidence: 99%

Defining a textbook surgical outcome for patients undergoing surgical resection of intermediate and high‐grade soft tissue sarcomas of the extremities

Lazarides

Cerullo

Moris

et al. 2020

Journal of Surgical Oncology

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Background Quality measures for the surgical management soft tissue sarcoma of the extremity are limited. The purpose of this study was to define a textbook surgical outcome (TO) for soft tissue sarcoma of the extremities (STS‐E) and to examine its associations with hospital volume and overall survival. Methods All patients in the National Cancer Database undergoing resection of primary STS‐E between 2004 and 2015 were identified. The primary outcome was a TO, defined as: hospital length of stay (LOS) <75th percentile, survival >90 days from the date of surgery, no readmission within 30 days of discharge, and negative surgical margins (R0 resection). Results Overall, 7658 patients met criteria for inclusion; a TO was achieved in 4291 (56%) patients. Of patients who did not achieve TOs, 51.9% (n = 1748) had an extended LOS, and 47.3% (n = 1591) did not have negative margins. Older age, more medical comorbidities, and non‐white or black race were independently associated with not receiving a TO (P = .034). With respect to tumor and treatment characteristics, larger tumor size, lower extremity location and higher grade were independently associated with not receiving a TO (P < .001). Hospital volume was not associated with a TO. TOs conferred a significant survival benefit (hazrds ratio = 0.71 [0.65‐0.78], P < .001). A TO was associated with a 27.5% longer survival time (P < .001). Conclusions This study defined a TO in intermediate and high‐grade STS‐E and demonstrated that this outcome measure is associated with overall survival. Facility volume was not associated with a TO.

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“…Most prior studies of bundled payments have been observational, focusing on the experience of a small number of hospitals that voluntarily participated. Many of these studies have found large government savings associated with bundled payments (e.g., Cromwell, Dayhoff and Thoumaian, 1997;Carroll et al, 2018;Newcomer et al, 2014;Doran and Zabinski, 2015;Dummit et al, 2016;Froemke et al, 2015;Navathe et al, 2017). However, voluntary participation makes separating treatment from selection difficult, and the small number of participating hospitals raises concerns about generalizability (e.g., Gronniger et al, 2017;King, 2019).…”

Section: Medicare Bundled Payment Programsmentioning

confidence: 99%

Voluntary Regulation: Evidence from Medicare Payment Reform

Einav

Finkelstein

et al. 2020

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Standardizing Care and Improving Quality under a Bundled Payment Initiative for Total Joint Arthroplasty

Cited by 86 publications

References 13 publications

Are Bundled Payments a Viable Reimbursement Model for Revision Total Joint Arthroplasty?

Are Bundled Payments a Viable Reimbursement Model for Revision Total Joint Arthroplasty?

Defining a textbook surgical outcome for patients undergoing surgical resection of intermediate and high‐grade soft tissue sarcomas of the extremities

Voluntary Regulation: Evidence from Medicare Payment Reform

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