Bundled Payments for Care Improvement: Lessons Learned in the First Year

Althausen, Peter L.; Mead, Lisa

doi:10.1097/bot.0000000000000715

Cited by 61Healthcare Policy and ManagementHealthcare Quality and ManagementHealthcare cost, quality, practices

Bundled Payments for Care Improvement: Lessons Learned in the First Year

Althausen, Peter L., Mead, Lisa·2016·Journal of Orthopaedic Trauma

DOI 10.1097/bot.0000000000000715

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Abstract

Summary: The Bundled Payments for Care Improvement (BPCI) initiative is the latest cost-saving program developed by the Center for Medicare and Medicaid Innovation. This model is intended to create a system for higher quality and more coordinated care at a lower cost to Medicare. It is currently an optional program for physician groups, hospitals and post-acute care providers to benefit financially from improved care models and cost containment measures. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. Under this initiative, there are certain fraud and abuse waivers in place that allow gainsharing among BPCI organizations and approved providers so long as certain requirements are met. Our practice entered this initiative for total joint arthroplasty episodes of care as well as the hip and femur fracture episode of care. The first year experience demonstrated that a significant learning curve is required. Keys for success include appropriate patient selection for elective surgery, implant pricing control, adherence to preoperative and postoperative protocols, diligent postcare care management, and appropriate choice of metrics to maximize gainsharing potential. Ultimately, the BPCI program has been a successful venture, saving our hospitals over $1.6 million in 2015. In the process, this provided an additional revenue stream for our physicians while decreasing the overall cost of care.

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Providers could experience substantial unreimbursed costs of implementing and sustaining EBPs.
“but providers could experience substantial unreimbursed costs of implementing and sustaining EBPs [65].”
From Translating economic evaluations into financing strategies for implementing evidence-based practices (2021) · cites this paper as [65]

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Authors: Althausen, P. L., & Mead, L.
Venue: Journal of Orthopaedic Trauma
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2016-12
Volume: 30
Issue: 5
Pages: S50-S53
ISSN: 0890-5339 (ISSN-L)
DOI: 10.1097/bot.0000000000000715
OpenAlex: W2554206765
Cited by: 61
References: 2
Citations by year: 2025: 1 · 2024: 3 · 2023: 3 · 2022: 1 · 2021: 6 · 2020: 9 · 2019: 14 · 2018: 19 · 2017: 5
FWCI: 24.61
Type: journal article
Language: en
Open access: closed
Locations: Journal of Orthopaedic Trauma (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
Keywords: Bundled Payments for Care Improvement, Medicare payment reform, cost containment, total joint arthroplasty, hip fracture, femoral fracture, gainsharing, episode of care, performance indicators, learning curve, hospital cost savings
MeSH terms: Cost Control, Medicare, Insurance, Health, Reimbursement, Nevada, United States, Models, Economic, Arthroplasty, Replacement, Quality Improvement, Patient Care Bundles

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Bundled Payments for Care Improvement: Lessons Learned in the First Year

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