1 4 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E A U G U S T 2 0 1 5
Saying it's over-
paying for inpa-
tient hip and
knee replace-
ments, CMS is
proposing a 5-
year bundled-
payment initia-
tive that would
put the onus on
hospitals in 75
geographic areas
to contain costs for lower-extremity joint-replace-
ment.
Medicare paid more than $7 billion for more
than 400,000 hip and knee replacements in
2013, according to CMS (osmag.net/cK8pMY),
with the average cost across geographic areas
ranging from $16,500 to $33,000. In some areas,
it says, complications such as infections and
implant failures were more than 3 times as com-
mon.
Under the proposed plan, hospitals "would be
held accountable for the quality and costs of care
… from the time of the surgery through 90 days
after discharge," says CMS. This, it says, would pro-
vide "an incentive to work with physicians, home
health agencies and nursing facilities to make
sure beneficiaries get the coordinated care they
need."
The plan would go into effect on January 1,
2016, and cover all hospitals in areas as geo-
graphically and demographically diverse as New
York; Los Angeles; Lubbock, Texas; and Fort
Collins, Colo. Hospitals in these locations may
qualify for additional payments or be forced to
reimburse Medicare for a portion of the costs,
depending on the facility's quality and cost per-
formance. Healthcare providers would continue
to be reimbursed under the current Medicare
model, according to CMS.
The full list of targeted areas appears on pages
58 and 59 of the proposed rule
(osmag.net/DafH2X), which was published in the
Federal Register on July 14. The comment period
runs until Sept. 8.
— Jim Burger
JOINT INITIATIVE
CMS to Test Bundled Payments for Total Knees and Hips
Mount
Carmel
Health
System
z COST CUTTING CMS wants to
reduce what it's paying for total
joints. Sanctioning outpatient pro-
cedures could be a solution.
