3-year pilot program finds bundled payments improve care, reduce cost

Measurable improvements in care quality and patient outcomes coincided with the implementation of bundled payment plans for patients undergoing total joint replacements, according to a new study.

The three-year study took place at NYU's Langone Medical Center in New York and was presented on March 2 at the American Academy of Orthopaedic Surgeons 2016 Annual Meeting in Orlando, Fla. The protocols utilized in the study were developed for NYU Lagone's participation in the Bundled Payment for Care Improvement pilot initiative sponsored by CMS.

For the study, researchers compared costs and outcomes of Medicare patients undergoing total joint replacement surgeries at NYU Langone's Hospital for Joint Diseases from year one of the BPCI pilot program to year three. Over the course of the study, average hospital length of stay decreased, discharges to inpatient rehabilitation facilities decreased, readmissions decreased and costs decreased.

"Key stakeholders and physicians across all areas of NYU Langone had to work together to create new protocols and guidelines to standardize care and ensure all patients have all the necessary resources before a surgery takes place and once at home to ensure the most optimal recovery possible," said Richard Iorio, MD, lead study author and chief of the division of adult reconstructive surgery at NYU Langone.

The new care models helped to cut 30-day readmissions by 2 percent, 60-day readmissions by nearly 5 percent and 90-day readmissions by approximately 5 percent. The average cost to CMS per episode of care reduced $34,249 to $27,541 over the three years of the program.

"Bundled care payment programs benefit everyone — our surgeons, the healthcare system, and most importantly, our patients," said Joseph Zuckerman, MD, the Walter A. L. Thompson Professor of Orthopaedic Surgery and chair of orthopaedic surgery at NYU Langone.

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