MedicalResearch.com Interview with:
Richard Iorio, MD
Dr. William and Susan Jaffe Professor of Orthopaedic Surgery
Chief of the Division of Adult Reconstructive Surgery
NYU Langone Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Iorio: NYU Langone Medical Center’s Department of Orthopaedic Surgery realized early that alternate payment strategies based on value rather than volume were going to be increasing in prevalence and represent the future of compensation strategies As leaders in orthopaedics, we knew that we must embrace this change and develop strategies and effective protocols to successfully navigate this alternative payment universe.
In 2011, NYU Langone’s Hospital for Joint Diseases was chosen as a pilot site for CMS’s Bundled Payment Care Initiative, focusing on Medicare patients undergoing a total joint replacement. Beginning in 2013, we implemented protocols developed at our hospital focusing on preoperatiive patient selection criteria in an effort to ensure better outcomes for Medicare patients who underwent total joint replacements. Under a bundled payment program, hospitals assume financial responsibility for any complications over the entire episode of care 90 days after surgery, including postsurgical infections and hospital readmissions.
We compared year over year outcomes from year 1 to year 3 of this program, and found:
- Average hospital length of stay decreased from 3.58 days to 2.96 days;
- Discharges to inpatient rehabilitation or care facilities decreased from 44 percent to 28 percent;
- Average number of readmissions at 30 days decreased from 7 percent to 5 percent; from 11 percent to 6.1 percent at 60 days; and from 13 percent to 7.7 percent at 90 days;
- The average cost to CMS of the episode of care decreased from $34,249 to $27,541 from year one to year three of the program.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Iorio: By 2019, an estimated 60 percent of Medicare reimbursements will shift towards this value-based health care system, so it’s important clinicians get ahead of this changing health care landscape and work together with hospital administration to implement evidence-based protocols on a systematic level to improve outcomes in patients, otherwise Medical Centers will be financially responsible for readmissions and complications. Our research shows that not only do patients benefit by having improved outcomes such as reduced length of stay, but there is financial incentive for physicians as well under the bundled payment system.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Iorio: Future research will look at how a bundled payment risk factor stratification and modification program to delay surgery in high-risk patients—such as those with conditions including morbid obesity, uncontrolled diabetes, neurocognitive and dependency issues, and cardiovascular and stroke complications—could impact patient outcomes and medical care.
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Abstract: Improvement in TJA Quality Metrics: Year One vs. Year Three of the Bundled Payment for Care Initiative
Presented at the: American Academy of Orthopaedic Surgeons (AAOS) 2016 Annual Meeting in Orlando, Florida
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Richard Iorio, MD (2016). NYU’s Orthopedic Bundled Care Plan Reduced Readmissions and Costs MedicalResearch.com