This month, hundreds of hospitals in 67 markets across the country started doing hip and knee replacements under Medicare's mandatory bundled-payment initiative. Experts say many weren't prepared to meet the tough challenges of the Comprehensive Care for Joint Replacement program, which requires hospitals to provide the procedure and all care for up to 90 days afterward for a target price.
But at least two health systems saw bundled payment for joint replacements coming and rigorously prepared themselves—CHI St. Alexius Health in Bismarck, N.D., and Pittsburgh-based UPMC. They convened multidisciplinary teams of surgeons, anesthesiologists, nurses, administrators, physical therapists and other staff to hone their clinical processes, purchasing of implants, patient education and post-acute care to optimize outcomes and reduce costs. It wasn't easy.
Their surgeons had to agree to standardize implant devices. Anesthesiologists had to adjust protocols to reduce nausea so patients could start physical therapy right after surgery. Nurses and physical therapists had to hustle to get patients ready for discharge the day after the procedure. Patients were asked to lose weight and control their blood sugar before surgery and take charge of their own care afterward—with far fewer stays in post-acute facilities. And post-acute providers had to fine-tune their care or be dropped from the referral network.