Abstract
Introduction
Bundled budgeting of payments for joint replacement services has become increasing common in an effort to improve quality while lowering cost. In the US, some Medicare bundled payment programs are voluntary whereas some now are mandatory. Large medical care and medical management organizations have largely been assigned or seized control of management of these programs, leaving the surgeon in a subordinate role. The current abstract describes an experience where surgeons provide leadership and accept responsibility in bundled payment program.
Methods
We engaged a collective of 16 different private company orthopedic physician groups to apply to become episode initiators under under the Medicare Bundled Payment for Care Improvement (BPCI) models 2 and 3. The application process itself provided historical
cost data, enabling each group to independently decide whether or not to proceed with the BPCI.
Results
Ultimately, 7 of the private orthopedic groups decided to continue with the BPCI initiative. At the first quarter reconciliation, savings ranged from 9% to 17% across the participating groups.
Conclusion
It is possible and potentially preferable for surgeons to take a primary role in accepting responsibility and leadership in the comprehensive care of joint replacement patients.
The surgeons are those who determine the indications for and perform the surgery, accept much of the risk, and typically maintain a career long relationship with the patient. As such, the surgeon is also in the best position to achieve the ultimate goals of improved quality which simultaneously controlling cost. Our experience thus far supports that view that the more leadership surgeons provide in value base care provision, the more our patients and health care system will benefit from optimization of care delivery.
