Bundled Payments

Bundled payment moves the payment model from a pay for each individual test, procedure, doctors visit to a single payment for a defined episode of care. Since this payment model is more procedure-based, orthopaedics and specifically, total joint replacements, will be on the radar for testing these payment models. There are a lot of total joints performed, the overall health care cost is in aggregate high and relatively speaking, they have a relatively low amount of variability in their care. All of these factors make total joints a targeted population for bundled care methods.

Accountable Care Organizations

An Accountable Care Organization (ACO) is a payment and delivery model that attaches provider reimbursements to quality metrics, as well as reductions in the total cost of care for an assigned population of patients. The accountable care model will force orthopaedics to move over time from an episodic management to a broader disease management base to include among others osteoarthritis and osteoporosis. The programs that adopt this broader management concept and effectively integrate the surgeon, non-surgeon and ancillary care providers will be the ones that win.

Pay For Performance

Pay for performance initiatives can take many forms. In this presentation, we focus on Medicare based initiatives. Over the past 5-10 years, Medicare has shifted from a passive payer of services into an active purchaser of higher quality, affordable care. Each year there is an increased emphasis on linking payment to quality and efficiency of care. The goal is quite simple: to provide higher quality at lower cost.