Alternative Payment Models in Total Joint Arthroplasty Under the Affordable Care Act

@article{izmi2019AlternativePM,
  title={Alternative Payment Models in Total Joint Arthroplasty Under the Affordable Care Act},
  author={Zlatan {\vC}izmi{\'c} and David Novikov and James E. Feng and Richard Iorio and Morteza Meftah},
  journal={JBJS Reviews},
  year={2019},
  volume={7},
  pages={e4}
}
Since the passage of the U.S. Patient Protection and Affordable Care Act (ACA), health care has transitioned from a volume-based enterprise to a quality-based enterprise. Under this legislation, Alternative Payment Models (Bundled Payments for Care Improvement [BPCI], Comprehensive Care for Joint Replacement [CJR], and Accountable Care Organizations [ACOs]) have been developed to provide stakeholders with reimbursement systems that reward high-quality care and cost reduction.The goal of this… 
View on Wolters Kluwer
ncbi.nlm.nih.gov
8 Citations

Tables from this paper

8 Citations

Are current DRG-based bundled payment models for revision total joint arthroplasty risk-adjusting adequately?

Under the proposed DRG-based bundled payment methodology, surgeons would be reimbursed the same amount of money for revision TJAs, regardless of the indication (periprosthetic fracture, prosthetic joint infection, mechanical loosening) and/or patient complexity.

Demographic, Comorbidity, and Episode of Care Trends in Primary Hip Arthroplasty: 2008 to 2018

Patient overall health status improved from 2008 to 2018, a reflection of a global shift toward value-based comprehensive care centering on patient optimization prior to arthroplasty, quality-of-care, and curtailing costs by mitigating perioperative adverse events.

Demographic, comorbidity, and episode of care trends in unicompartmental knee arthroplasty: 2008 to 2018

From 2008 to 2018, there was minimal improvement in UKA patients’ modifiable comorbidities, but the findings showed improvement in episode-of-care outcomes, implying that the value of UKA has been increasing over the last decade.

A Call for a Standardized Approach to Reporting Patient-Reported Outcome Measures: Clinical Relevance Ratio.

It is demonstrated that when a study's outcome is PROMs, clinical importance should be reported using clinical thresholds such as the minimum clinically important difference (MCID), the smallest change in the treatment outcome that a patient perceives as beneficial, and the patient acceptable symptom state (PASS), the highest level of symptoms beyond which a patient considers himself or herself well.

Preoperative Patient Expectation of Discharge Planning is an Essential Component in Total Knee Arthroplasty

Physician-driven discussion regarding patient discharge did not alter patient satisfaction or length of stay but did correlate with improved odds of home discharge, underscore the importance of patient education, shared decision-making, and managing patient expectations.

Temporal Trends in Revision Total Hip and Knee Arthroplasty from 2008 to 2018: Gaps and Opportunities.

Time-difference analysis demonstrated that the overall health status of patients undergoing revision TJA improved from 2008 to 2018, and formal time-trend analysis demonstrated improvements to a lesser degree.

Patient-reported outcomes at 1 and 2 years after total hip and knee arthroplasty: what is the minimum required follow-up?

  • N. PiuzziMarcelo BP Peter A Wael K. Isaac Carlos A Alison K Melissa Siqueira Surace Barsoum Briskin Higuera Rueda Klik N. Piuzzi
  • Medicine
    Archives of Orthopaedic and Trauma Surgery
  • 2021
Data support a minimum follow-up of 1 year for studies with PROMs as the primary outcome variable following total hip (THA) or knee (TKA) arthroplasty and minimal demographic or baseline differences between responders and non-responders suggest a representative sample.

Meaningful Clinical Applications of Patient-Reported Outcome Measures in Orthopaedics.

  • E. Makhni
  • Medicine
    The Journal of bone and joint surgery. American volume
  • 2020

References

SHOWING 1-10 OF 30 REFERENCES

Alternative payment models: From bundled payments for care improvement and comprehensive care for joint replacement to the future?

The goal of this article is to report on the various bundle payment initiatives sanctioned by CMS, and how these innovative reimbursement systems may affect orthopedic practice.

Optimizing Outcomes of Total Joint Arthroplasty Under the Comprehensive Care for Joint Replacement Model.

On July 9, 2015, the Centers for Medicare and Medicaid Services announced the Comprehensive Care for Joint Replacement model, which aims to improve coordination of the whole episode of care for total…

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

Bundled payments have the potential to be a viable reimbursement model for revision TJA, despite the unpredictable nature of the surgical procedures, inherent high risks of complications, and varying degrees of surgical complexity.

Managing episodes of care: strategies for orthopaedic surgeons in the era of reform.

This article seeks to demystify the episode-of-care bundled payment methodology, provide a roadmap of what orthopaedic surgeons can do to participate in this demonstration project, and present strategies to mitigate the inherent risks.

Improvement in Total Joint Replacement Quality Metrics: Year One Versus Year Three of the Bundled Payments for Care Improvement Initiative.

Mid-term results from the implementation of Medicare BPCI Model 2 for primary total joint arthroplasty demonstrated decreased LOS, decreased discharges to inpatient facilities, decreased readmissions, and decreased cost of the episode of care in year 3 compared with year 1, resulting in increased value to all stakeholders involved in this initiative and suggesting that continued improvement over initial gains is possible.

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

Bundled Payments for Care Improvement: Lessons Learned in the First Year

Summary: The Bundled Payments for Care Improvement (BPCI) initiative is the latest cost-saving program developed by the Center for Medicare and Medicaid Innovation. This model is intended to create a…

Understanding Value-based Reimbursement Models and Trends in Orthopaedic Health Policy: An Introduction to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015

  • K. SalehW. Shaffer
  • Medicine, Political Science
    The Journal of the American Academy of Orthopaedic Surgeons
  • 2016
A contextual framework of the healthcare legislation that has led to the formation of current health policy is provided and recommendations regarding SGR how orthopaedic surgeons may best steer through such reimbursement models are offered.

What is the Best Strategy to Minimize After-Care Costs for Total Joint Arthroplasty in a Bundled Payment Environment?

Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Improvement Initiative.