title: The 5 Clinical Pillars of Value for Total Joint Arthroplasty in a Bundled Payment Paradigm.
abstract: Our large, urban, tertiary, university-based institution reflects on its 4-year experience with Bundled Payments for Care Improvement. We will describe the importance of 5 clinical pillars that have contributed to the early success of our bundled payment initiative. We are convinced that value-based care delivered through bundled payment initiatives is the best method to optimize patient outcomes while rewarding surgeons and hospitals for adapting to the evolving healthcare reforms.
  
  
  
  We summarize a number of experiences and lessons learned since the implementation of Bundled Payments for Care Improvement at our institution.
  
  
  
  Our experience has led to the development of more refined clinical pathways and coordination of care through evidence-based approaches. We have established that the success of the bundled payment program rests on the following 5 main clinical pillars: (1) optimizing patient selection and comorbidities; (2) optimizing care coordination, patient education, shared decision making, and patient expectations; (3) using a multimodal pain management protocol and minimizing narcotic use to facilitate rapid rehabilitation; (4) optimizing blood management, and standardizing venous thromboembolic disease prophylaxis treatment by risk standardizing patients and minimizing the use of aggressive anticoagulation; and (5) minimizing post-acute facility and resource utilization, and maximizing home resources for patient recovery.
  
  
  
  From our extensive experience with bundled payment models, we have established 5 clinical pillars of value for bundled payments. Our hope is that these principles will help ease the transition to value-based care for less-experienced healthcare systems.
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
mesh_terms: D001178:Arthroplasty; D019643:Arthroplasty, Replacement / Q000191:economics* / Q000592:standards*; D003695:Delivery of Health Care; D018166:Health Care Reform; D005102:Health Expenditures; D006801:Humans; D064872:Patient Care Bundles
keywords: alternative payment models; bundled payments; comprehensive care for joint replacement; total joint arthroplasty; value-based care