title: The Physician as the Provider at Risk: Rolling the Dice.
abstract: There is significant need for physician innovation and leadership in health care as we adapt to bundled payment models of health care delivery.
  
  
  
  We engaged a collective of 16 different private company orthopedic physician groups to apply to become episode initiators under 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 initiative.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Orthopaedic Surgery, Tufts University School of Medicine, New England Baptist Hospital, Boston, Massachusetts.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Murphy
authors.affiliation: Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Disease, New York, New York.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Bolz
authors.affiliation: Archway Health Advisors, Harvard Innovation Launch Lab, Allston, Massachusetts.
authors.forename: David P
authors.initials: DP
authors.lastname: Terry
authors.affiliation: Department of Orthopaedic Surgery, Tufts University School of Medicine, New England Baptist Hospital, Boston, Massachusetts.
authors.forename: Carl T
authors.initials: CT
authors.lastname: Talmo
authors.affiliation: Excel Orthopaedic Specialists, Woburn, Massachusetts.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Fehm
mesh_terms: D001178:Arthroplasty / Q000379:methods; D003625:Data Collection; D003695:Delivery of Health Care / Q000191:economics*; D017050:Episode of Care; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D009985:Orthopedics / Q000191:economics* / Q000379:methods*; D064872:Patient Care Bundles / Q000191:economics*; D010820:Physicians
keywords: bundled payments for care improvement; comprehensive care for joint arthroplasty; gainsharing; managed care organization; physician group practice; value-based purchasing