5 key thoughts on lessons learned from early orthopedic bundled payments

A new study published in the Journal of the American Academy of Orthopaedic Surgeons examines New York City-based NYU Langone Medical Center's initial attempts to achieve cost savings with orthopedic bundled payments under the CMS Bundled Payments for Care Improvement initiative.
The study authors examined patients who underwent lower extremity joint replacements, cardiac valve procedures or spine surgery from April 2011 to June 2012 and October 2013 to December 2014. The researchers also examined individuals hospitalized for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopedic care and stroke as a control group.
The study compared 2,940 interventional episodes and 1,474 control episodes. The researchers found:
1. Lower extremity joint replacement bundled payments achieved the greatest cost savings, lowering costs $3,017 during the intervention period.
2. The average cost for cardiac procedures decreased $2,999 when the bundled payments were implemented.
3. The bundled payment program increased costs for spinal fusions by $8,291. According to the study authors, spinal fusion index admission costs were higher due to surgical technique changes.
4. NYU Langone created the most savings by discharging patients home instead of to inpatient rehabilitation facilities.
5. Over the study period, the proportion of patients discharged to inpatient rehabilitation facilities decreased among all procedures. However, the changes weren't associated with increased index hospital length of stay or readmission rates.
"Opportunities for savings under bundled payment may be greater for lower extremity joint arthroplasty than for other conditions," concluded study authors.

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