What Bundled Payment Structure Should Physical Therapists Support for Patients After Total Hip and Knee Arthroplasty?

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J Jackson, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA


Background: The passing of the Affordable Care Act (ACA) in 2010 set new standards for health care and payer reform. The Center for Medicare and Medicaid Innovation has been charged with the task of piloting new payment programs, including bundled payment methods. Total knee and hip replacements account for a large portion of Medicare spending yearly and the rate of these procedures continues to rise. Many bundled programs target these patients because they are high volume and predictable in recovery. The goal of this paper is to analyze bundled payments as a health policy for this population and lead physical therapists, significant clinical providers for these patients, in supporting such payment structures for the future. Methods: Extensive literature review and interviews of experts in the bundled payment field were completed. Bundled payments are analyzed as a health policy, current programs are addressed, policy options identified, and therapists provided recommendations to support implementation in the future. Summary: The Bundled Payment for Care Improvement, Prometheus, and Comprehensive Joint Replacement Models offer alternate payments methods for total hip and knee replacements. Each bundle provides pros and cons for health systems and patients. Physical therapists could support the current fee for service model or one of these three models as a policy plan. Conclusion: After a literature review and considering the role of the physical therapist in TKR and THR, it is recommended that the Prometheus Model be utilized as a policy by CMS for bundled payment. There are multiple policy reforms therapists should support to assist with bundled payment including Telehealth privileges, shared billing and assessment for post acute providers, and fair outpatient copays. Therapists will need to prepare for the future of bundled payment and consider their role in patient recovery in order to be primary stakeholders in these payment systems.

Presentation: 43:10

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