Implementing a bundled payment program for total hips

Bundled payments (ie, episode-based payments) are an alternative to the current fee-for-service system and are intended to contain healthcare costs and promote quality.

In July 2015, the Centers for Medicare & Medicaid Services proposed the Comprehensive Care for Joint Replacement Model, which will test bundled payment for hip and knee replacement by requiring all hospitals to participate in 75 geographic areas.

However, the impact of bundled payments on clinical and financial outcomes remains uncertain, and the best approach to creating and implementing such a program is not well established.

In this study, researchers describe Baystate Health System’s (Springfield, Massachusetts) experience in developing and implementing a bundled payment program and examine its effects on quality and cost for patients undergoing total hip replacement.
Compared to controls, patients under the bundled payment program had:

• similar length of stay (3.0 vs 3.4 days)
• higher rates of discharge to home or home with services than to a rehabilitation facility (87% vs 63%)
• similar adjusted median total payments ($22,272 vs $22,576)
• lower median posthospital payments ($704 vs $1,121)
• greater likelihood of receiving guideline-consistent care (99% vs 95%).

The bundled payment program for total hip replacement was associated with similar total costs, lower posthospital costs, shorter length of stay, and similar or higher quality hospital care, the researchers concluded.

—Whitcomb W F, Lagu T, Krushell R J, et al. Experience with designing and implementing a bundled payment program for total hip replacement. Jt Comm J Qual Patient Saf. 2015;41(9):406-413.

http://www.ingentaconnect.com/content/jcaho/jcjqs/2015/00000041/00000009/art00003