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. 2015 Oct;30(10):1676-82.
doi: 10.1016/j.arth.2015.04.028. Epub 2015 May 5.

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

Cecily C Froemke  1 , Lian Wang  1 , Matthew L DeHart  1 , Ronda K Williamson  1 , Laura Matsen Ko  2 , Paul J Duwelius  3
Affiliations

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

Cecily C Froemke et al. J Arthroplasty. 2015 Oct.

Abstract

Increasing demands for episodic bundled payments in total hip and knee arthroplasty are motivating providers to wring out inefficiencies and coordinate services. This study describes a care pathway and gainshare arrangement as the mechanism by which improvements in efficiency were realized under a bundled payment pilot. Analysis of cut-to-close time, LOS, discharge destination, implant cost, and total allowed claims between pre-pilot and pilot cohorts showed an 18% reduction in average LOS (70.8 to 58.2 hours) and a shift from home health and skilled nursing facility discharge to home self-care (54.1% to 63.7%). No significant differences were observed for cut-to-close time and implant cost. Improvements resulted in a 6% reduction in the average total allowed claims per case.

Keywords: THA; TKA; bundled payment; care pathway; gainsharing; reimbursement.

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