CMS Experiment Combines Payments to Orthopedic Surgeon, Hospital

CMS’ experiment with “bundling” orthopedic charges into one payment for both the hospital and surgeon is getting mixed reviews from physicians, but it could be the wave of the future, according to a feature in USA Today.

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At Hillcrest Medical Center in Tulsa, Okla., one of five hospitals nationwide to participate in the Medicare pilot project, Orthopedic Surgeon Yogesh Mittal, MD, said he hasn’t had any problems getting his share of the bundled payment from the hospital, as many physicians have feared.

For the a knee replacement that Dr. Mittal performed, Medicare made a bundled payment to the hospital and physician of $13,211, about $450 less than normal, and paid the patient $271 for choosing the hospital.

The current pilot covers orthopedic and cardiac surgery payments at Hillcrest and Baptist Health System in San Antonio and is expected to start at three more hospitals in Denver, Albuquerque and Oklahoma City this year.

Legislation in Congress would expand the program if it can be shown to attract more patients to participating hospitals.

A CMS bundling pilot for coronary bypass surgery in the mid-1990s saved Medicare $42.3 million over three years, and while participating hospitals did not see an increase in patient volume, it was probably because patients in that study were not getting incentive payments.

Read USA Today’s feature on bundling payments for physicians and hospitals.

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