The United States continues to spend an unprecedented amount of annual money on healthcare. However, the costs of providing care may not appropriately reflect the quality of care patients are receiving. This is particularly concerning when examining the projected increase in total joint arthroplasty (TJA) procedures over the next few decades, which are expected to increase to nearly 4 million procedures annually. The Center for Medicare and Medicaid Services (CMS) has responded by increasingly shifting reimbursements from the less efficient fee-forservice repayment model to value-based repayment. The Comprehensive Care for Joint Replacement (CJR) bundle payment model has recently been implemented as part of this shift towards value-based care delivery. The CJR repayment model, developed based on the success of the elective Bundled Payments for Care Improvement (BPCI) initiative, is an episodic bundled payment for TJA procedures, putting more financial responsibility on hospitals with the aim of improving quality of care, reducing costs, and decreasing local and regional cost and quality variability amongst providers and hospitals. I reviewed current studies on the BPCI and CJR model, including benefits associated with reducing patient readmissions to the hospital; limited costs and postoperative complications associated with post-acute care facilities and patient length of stay; and instituting evidence-based protocols for preoperative, perioperative, and postoperative care. Promising data exists that suggests these programs may help incentivize reducing costs and improving the quality of care provided to patients undergoing TJA procedures.
Decker, Michael M.. "Value-Based Bundled Repayment in Total Joint Arthroplasty." UNM Orthopaedic Research Journal 6, 1 (2017). https://digitalrepository.unm.edu/unm_jor/vol6/iss1/14