title: Standardizing Care and Improving Quality under a Bundled Payment Initiative for Total Joint Arthroplasty.
abstract: Increasing demands for episodic bundled payments in total hip and knee arthroplasty are motivating providers to wring out inefficiencies and coordinate services. This study describes a care pathway and gainshare arrangement as the mechanism by which improvements in efficiency were realized under a bundled payment pilot. Analysis of cut-to-close time, LOS, discharge destination, implant cost, and total allowed claims between pre-pilot and pilot cohorts showed an 18% reduction in average LOS (70.8 to 58.2 hours) and a shift from home health and skilled nursing facility discharge to home self-care (54.1% to 63.7%). No significant differences were observed for cut-to-close time and implant cost. Improvements resulted in a 6% reduction in the average total allowed claims per case.
authors.affiliation: Providence Health & Services, Portland, Oregon.
authors.forename: Cecily C
authors.initials: CC
authors.lastname: Froemke
authors.affiliation: Providence Health & Services, Portland, Oregon.
authors.forename: Lian
authors.initials: L
authors.lastname: Wang
authors.affiliation: Providence Health & Services, Portland, Oregon.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: DeHart
authors.affiliation: Providence Health & Services, Portland, Oregon.
authors.forename: Ronda K
authors.initials: RK
authors.lastname: Williamson
authors.affiliation: Providence St. Vincent Medical Center, Portland, Oregon; Oregon Health and Sciences University, Portland, Oregon.
authors.forename: Laura Matsen
authors.initials: LM
authors.lastname: Ko
authors.affiliation: Providence St. Vincent Medical Center, Portland, Oregon.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Duwelius
mesh_terms: D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics; D001291:Attitude of Health Personnel; D003365:Costs and Cost Analysis; D017050:Episode of Care; D005102:Health Expenditures; D006801:Humans; D008875:Middle Aged; D058996:Quality Improvement
keywords: THA; TKA; bundled payment; care pathway; gainsharing; reimbursement