Starting April 1, 800 hospitals in 67 metropolitan statistical areas will implement the Comprehensive Care for Joint Replacement Model, an alternative payment model by which the Centers for Medicare and Medicaid will pay hospitals based on the quality of hip and knee replacement procedures offered to Medicare beneficiaries.
As such the topic was of great interest at the annual meeting of the American Academy of Orthopaedic Surgeons that kicked off in Orlando on Tuesday.
The bundled payment model seeks to look at an entire episode of care — from 3 days prior to surgery all the way to 90 days post surgery — and pay providers based on good outcomes for each of those episodes. These could be low infection rates, reduced hospital admissions and other metrics.If providers perform well — in other words the cost of the care is lower than the target price set for each hospital implementing the program, then the hospital wins. If, however, the cost of doing hip and knee surgeries is above the target price, in year two of the program, providers will have to pay back the amount over the target price to CMS.