Early Results of Medicare's Bundled Payment Initiative for a 90-Day Total Joint Arthroplasty Episode of Care

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• 作者：Richard Iorio ; MD ; Andrew J. Clair ; MD ; Ifeoma A. Inneh ; MPH ; James D. Slover ; MD ; MS ; Joseph A. Bosco ; MD ; Joseph D. Zuckerman ; MD
• 关键词：total knee arthroplasty ; total hip arthroplasty ; health care economics ; health care policy ; practice management
• 刊名：The Journal of Arthroplasty
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：31
• 期：2
• 页码：343-350
• 全文大小：1200 K

文摘

In 2011 Medicare initiated a Bundled Payment for Care Improvement (BPCI) program with the goal of introducing a payment model that would “lead to higher quality, more coordinated care at a lower cost to Medicare.”

d="absSec_2">Methods

d="sp1005">A Model 2 bundled payment initiative for Total Joint Replacement (TJR) was implemented at a large, tertiary, urban academic medical center. The episode of care includes all costs through 90 days following discharge. After one year, data on 721 Medicare primary TJR patients were available for analysis.

d="absSec_3">Results

d="sp2005">Average length of stay (LOS) was decreased from 4.27 days to 3.58 days (Median LOS 3 days). Discharges to inpatient facilities decreased from 71% to 44%. Readmissions occurred in 80 patients (11%), which is slightly lower than before implementation. The hospital has seen cost reduction in the inpatient component over baseline.

d="absSec_4">Conclusion

d="sp3005">Early results from the implementation of a Medicare BPCI Model 2 primary TJR program at this medical center demonstrate cost-savings.

d="absSec_5">Level of Evidence

d="sp4005">IV economic and decision analyses—developing an economic or decision model