title: You Want a Successful Bundle: What About Post-discharge Care?
abstract: The postacute care strategies after total joint arthroplasty, including the use of postacute rehabilitation centers and home therapy services are associated with different costs. Providers in bundled payment programs are incentivized to use the most cost-effective strategies while maintaining quality and value for patients.
  
  
  
  We discuss the impact of postacute care on a bundled payment program and strategies for optimizing the value of this component of the care episode using the experience of a large academic urban medical center participating in the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement Initiative.
  
  
  
  The results of this analysis show that efforts to increase the use of home discharge and decrease the use of postacute facilities after elective primary total hip and knee arthroplasties can lead to cost-effective quality care with a high degree of patient satisfaction.
  
  
  
  The postdischarge period is a significant part of a bundled payment episode. To manage a successful bundled payment program in total joint arthroplasty, significant efforts to coordinate care during this episode are needed for patients to receive quality care that meets their expectations.
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: James D
authors.initials: JD
authors.lastname: Slover
mesh_terms: D000046:Academic Medical Centers; D001178:Arthroplasty / Q000191:economics*; D019644:Arthroplasty, Replacement, Hip / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000191:economics; D014487:Centers for Medicare and Medicaid Services, U.S.; D003362:Cost-Benefit Analysis; D017050:Episode of Care; D005102:Health Expenditures; D006801:Humans; D007902:Length of Stay; D006278:Medicare / Q000191:economics*; D064872:Patient Care Bundles / Q000191:economics*; D010351:Patient Discharge; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000191:economics*; D011787:Quality of Health Care; D014481:United States
keywords: bundled payment; discharge disposition; total hip arthroplasty; total joint arthroplasty; total knee arthroplasty