Making Medicare's Hip and Knee Replacement Bundles Work

Working Out Other Program Kinks

The program still has some kinks, Dr Higuera says. Although Cleveland Clinic is making more money than it did with fee-for-service on elective hip and knee replacements, it is losing money on hip fractures, which have a much higher complication rate. Unlike the CJR, the bundled program that the Cleveland Clinic is using doesn't include higher payments for these patients.

"It's important that every surgeon or hospital understand what type of population they are dealing with and have some sort of modeling to understand which patients are at higher risk for adverse outcomes," says Dr Higuera. "Those patients are probably better off if they're outside the bundled payments."

So far, the clinic hasn't been able to negotiate an arrangement with CMS to treat such high-risk patients differently. However, "they have been receptive," he says. "The overall concept has not changed, but hopefully in the future it will."

Despite this drawback, Cleveland Clinic has liked bundling well enough to expand the program from its Euclid campus to its other orthopedic facilities. And it has embraced similar bundling programs through Medicaid and commercial health plans.

"So far, what we have found is that we have been pretty successful," says Dr Higuera, "because in the end, it does improve patient care."

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Cite this: Making Medicare's Hip and Knee Replacement Bundles Work - Medscape - Apr 28, 2016.