Medicare Bundled Payment Programs for Joint Replacement: Anatomy of a Successful Payment Reform

• Published in: JAMA : the journal of the American Medical Association Vol. 320; no. 9; pp. 877 - 879
• Main Author: Ryan, Andrew M
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 04-09-2018
• Subjects: Arthroplasty, Replacement; Government programs; Health care; Health care expenditures; Health Expenditures; Hospitals; Joint replacement surgery; Laboratory tests; Medicare; Payment systems; Payments; Reimbursement; Reimbursement Mechanisms; United States; Workflow
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2018.11787

Since its inception, how Medeicare pays hospitals has been a work in progress. Medicare originally paid hospitals by reimbursing them for the cost of each "item" of care delivered, such as laboratory tests, medications, and procedures. While this was advantageous for hospitals, it ultimately led to an unsustainable increase in Medicare spending. The Centers for Medicare & Medicaid Services have now initiated additional Medicare payment reform, from prospective payment to bundled payment, which extends the clinical episode to include not only the hospitalization but also postdischarge care, generally up to 90 days after discharge.