A bundled payment program specific to the treatment of knee replacement surgery is now available through a collaboration between Florida Blue and Mayo Clinic.
The program is designed to offset the costs of this surgery, which is considered to be the most common joint replacement procedure in the United States, and is performed on more than 600,000 patients annually, according to the AHRQ. Similar to many surgical procedures, knee replacement involves many individual medical procedures and processes. When done separately, the costs add up quickly. This bundled program compresses the costs into one amount, a factor that will eventually provide stakeholder savings, they say.
Some of the primary procedures that will be included in the bundled package include the following:
- All related surgical procedures that are part of the knee replacement;
- Anesthesia services;
- Injections or drugs administered during the surgical procedure, including antibiotics;
- Radiology/Imaging services;
- Cost of the implant and surgical supplies;
- Discharge planning and nursing care; and
- Office visits.
The bundled payment agreement, which took effect Dec. 15, 2012, applies to all Florida Blue commercial plans, excluding Go Blue and Cover Florida plans.
Source: Florida Blue, December 14, 2012
Case Study in Bundled Payments: The Baptist Health System Experience This 24-page report documents the care payment experience of Baptist Health System in the CMS ACE demonstration pilot, which aligned payment for services delivered across episodes of care or “bundled” care. ACE focused on the cardiac and orthopedic diagnosis-related group (DRGs), two of the public payor’s most frequent and largest cost disease areas.