For many procedures and treatment pathways (e.g., a total knee replacement), there are distinct points along an episode of care that a patient progresses through. However, at each point, there is tremendous physician and staff variability in practice leading to significant inefficiency and high costs. Bundled payments are an alternative payment structure, which reimburse healthcare providers, on the basis of expected costs for standardized clinically-defined episodes of care. Bundled payments aim to reduce healthcare costs for specific episodes of care by encouraging providers to redesign care delivery through: (1) reducing variability; (2) increasing efficiency; and (3) improving outcomes.
Surgeons from our Orthopedic and Neurosurgery departments developed evidence-based clinical care pathways for patients undergoing a total knee replacement or spinal surgery from pre-operative consultations through post-operative rehabilitation and follow up appointments.
Results to date:
We are currently piloting our knee replacement care pathway at Brigham and Women's Hospital. Physician-level metrics such as OR time, hospital length of stay, and discharge disposition will be monitored and reported regularly as will quality and safety metrics such as patient readmission and complication rates. We expect to have results soon.