title: Bundled payments for care improvement initiative: the next evolution of payment formulations: AAHKS Bundled Payment Task Force.
abstract: The Patient Protection and Affordable Care Act contains a number of provision for improving the delivery of healthcare in the United States, among the most impactful of which may be the call for modifications in the packaging of and payment for care that is bundled into episodes. The move away from fee for service payment models to payment for coordinated care delivered as comprehensive episodes is heralded as having great potential to enhance quality and reduce cost, thereby increasing the value of the care delivered. This effort builds on the prior experience around delivering care for arthroplasty under the Acute Care Episode Project and offers extensions and opportunities to modify the experience moving forward. Total hip and knee arthroplasties are viewed as ideal treatments to test the effectiveness of this payment model. Providers must learn the nuances of these modified care delivery concepts and evaluate whether their environment is conducive to success in this arena. This fundamental shift in payment for care offers both considerable risk and tremendous opportunity for physicians. Acquiring an understanding of the recent experience and the determinants of future success will best position orthopaedic surgeons to thrive in this new environment. Although this will remain a dynamic exercise for some time, early experience may enhance the chances for long term success, and physicians can rightfully lead the care delivery redesign process.
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Froimson
authors.forename: Adam
authors.initials: A
authors.lastname: Rana
authors.forename: Richard E
authors.initials: RE
authors.lastname: White
authors.forename: Amanda
authors.initials: A
authors.lastname: Marshall
authors.forename: Steve F
authors.initials: SF
authors.lastname: Schutzer
authors.forename: William L
authors.initials: WL
authors.lastname: Healy
authors.forename: Peggy
authors.initials: P
authors.lastname: Naas
authors.forename: Gail
authors.initials: G
authors.lastname: Daubert
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.forename: Brian
authors.initials: B
authors.lastname: Parsley
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000191:economics; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics / Q000639:trends*; D003695:Delivery of Health Care / Q000191:economics / Q000639:trends*; D018588:Fee-for-Service Plans / Q000191:economics; D017048:Health Care Costs / Q000639:trends; D018166:Health Care Reform / Q000191:economics; D006801:Humans; D009985:Orthopedics / Q000191:economics; D064872:Patient Care Bundles / Q000191:economics*; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000639:trends*; D011787:Quality of Health Care / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics / Q000639:trends*; D012189:Retrospective Studies; D014481:United States
keywords: Medicare; arthroplasty; bundled payment; episode of care; healthcare reform