AAHKS Symposium: The Future is Here - Bundled Payments and ICD-10
Bundled Payments: Our Experience at an Academic Medical Center

https://doi.org/10.1016/j.arth.2016.01.055Get rights and content

Abstract

Background

The landscape of health care is transitioning from a fee-for-service model to value-based purchasing.

Methods

We developed evidence-based clinical pathways and risk stratification measures to effectively implement the Bundled Payments for Care Improvement model of value-based purchasing.

Results

We decreased patients' length of stay, discharge to inpatient facilities, and cost of an episode of patient care.

Conclusion

The bundled care payment initiative has been successfully implemented for Diagnosis Related Groups 469 and 470, delivering high-quality patient care at a reduced price.

Section snippets

Episode of Care

NYULMC Hospital for Joint Diseases (HJD) implemented the model 2 90-day BPCI for total joint arthroplasty MS-DRGs 469 and 470 beginning in January of 2013. Under this alternative payment program, the entirety of a patient’s episode of care is covered by a single bundled payment. CMS defines an episode of care as “all Medicare Part A and Part B services provided by an entity wholly-owned or operated by the admitting hospital in the 72 hours prior to admission, surgeon fees, anesthesiologist

Results

Through the first year of program eligibility, the 2013 fiscal year (FY), 721 patients were successfully integrated into the BPCI program. In the first 2 quarters, we appreciated an 8.1% and 17% savings for DRGs 469 and 470, respectively. Those savings were maintained throughout the 2014 reconciliations. During the baseline 3 years (2009-2012), NYULMC experienced an average length of hospital stay of 5.31, 4.60, and 4.43 days in consecutive years. In the 2013 FY, NYULMC achieved a decrease in

Bundled Payments for Care Improvement

NYULMC HJD has shown that the BPCI model 2 can be successfully implemented at a tertiary care, epidemic, urban medical center with a hybrid compensation model. NYULMC was able to establish an evidenced-based pathway system for patient care and develop the proper infrastructure for it to run efficiently. After 2 years of the program, NYULMC was able to decrease hospital length of stay, decrease discharges to inpatient facilities, and decrease the cost of the episode of care of each patient.

Conclusion

NYULMC has successfully implemented value-based purchasing through the use of the BPCI 2 model. Since January 2013, NYULMC has achieved a significant decrease in patients' length of stay, discharge to inpatient facilities, and cost of the episode of care. NYULMC had not significantly altered readmission rates in the 2013 FY, but during 2014, the readmission rates were decreased because of improved care management and preoperative risk factor optimization. In addition to increased cost

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One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.01.055.

The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of the Centers for Medicare and Medicaid Services. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

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