HHS announces mandated bundled payments for hip, knee replacement
Hip and knee replacement to be treated as one service, from day of surgery until 90 days later.
Health and Human Services Secretary Sylvia Burwell on Thursday unveiled a mandatory bundled pay model for hip and knee replacement.
Under the new proposed rule, providers offering hip and knee replacement would treat the service as one complete service, including the recovery afterward, Burwell said.
The five-year mandatory model would give healthcare providers a standard set of quality measures, including measures for complications and readmissions.
Actual spending would be compared to price, she said.
Depending on the quality, the hospital may receive an additional payment or have to pay Medicare.
Bundling the payments is an incentive for patient care, a patient-centered approach, Burwell said.
Centers for Medicare and Medicaid Chief Medical Officer Dr. Patrick Conway said, "We're proposing a model for a vast majority of hospitals in 75 metro hospitals from the time of surgery until 90 days after."
Burwell said there were over 400,000 such procedures in 2013. Despite the prevalence of the surgery, the cost varies greatly from $16,500 to $33,000, Burwell said.
Rate of complications can be three times higher at some facilities than others, she said.
"We know this will be a change, we would ask providers to learn new approaches," she said.
A 60-day comment period is in effect for the proposed rule.
The Centers for Medicare and Medicaid has said it wants 30 percent of payments tied to alternative models by 2016 and 50 percent by end of 2018.
