FinancialRecon

Joint replacement bundled payments losing their appeal in BPCI Advanced

HARRIS MEYER  / January 24, 2020

Analyses of CMS data on Medicare’s largest bundled-payment demonstration suggest providers may have reached the limit of their ability to streamline joint replacement procedures.

While the joint replacement bundle for hips and knees has been one of the most popular of Medicare’s Bundled Payment for Care Improvement Advanced program, providers are shifting to bundles for medical and chronic conditions like sepsis and chronic obstructive pulmonary disease.

On total joints, participants already may have done all they could to make care more cost-effective by reducing use of post-acute skilled nursing care, said Dr. Amol Navathe, assistant professor of health policy at University of Pennsylvania who studies bundled payment models.

For physician groups, the bundle for back and neck except spinal fusion replaced total joint replacement of the hip and knee as the mostly commonly selected episode—with 34% choosing back and neck, while selection of the joint replacement bundle plunged to 22% from 77%.

The target pricing on the joint replacement bundle often is moving lower, making it harder for providers to be financially successful with it, said Keely Macmillan, senior vice president of policy for Archway Health.

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Mike Adams

Mike Adams is a medical device sales leader with extensive clinical experience in spine and biologics and a nationwide distribution network built over the last 10+ years in the industry. He has held various leadership positions in healthcare and device including Distributor Partner, Hospital COO and Spine VP of Sales. He currently leads the commercialization strategy for OrthoSpine Partners and is a Distributor Principal at Novel Medical. Because of his unique career path, Mike has the ability to see the healthcare business from multiple perspectives making him passionate about building strategic partnerships that help reduce overall costs, drive innovation, and cultivate growth for new markets.

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