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2 payment models incentivizing cost-effective joint replacements

Joint replacement procedures are migrating to outpatient facilities with the help of innovative payment models, according to Fusion5, a company focused on building partnerships to advance value-based care.

The number of hip replacement procedures performed each year will increase 171 percent by 2030, according to a Fusion5 post citing research presented at the 2018 AAOS Annual Meeting. 

Meanwhile, joint replacement costs vary significantly. In Dallas, a hip replacement can cost anywhere from $21,000 to $99,000, Fusion5 said.

The company highlighted two payment models incentivizing "cost-effective, exceptional care" in the midst of these trends:

1. Horizon Blue Cross introduced an episode of care program that reportedly reduced hip replacement costs by more than 20 percent for New Jersey providers.

2. Beginning in 2020, CMS will include a total knee arthroplasty outpatient bundle in the Bundled Payments for Care Improvement Advanced Model.

"The rapid increase in the number of joint-replacement surgeries is inevitable. Longer lifespans and an aging population mean these procedures are going to continue to increase," said Fusion5 CEO Jim Gera. "However, patients, providers and taxpayers do not have to accept wild swings in the cost and quality of care. Taking a value-based, episode of care centered approach that incentivizes outpatient treatment means that patients can continue to receive innovative, exceptional care at a reasonable cost."

More articles on coding, billing and collections:
5 interesting ASC company partnerships to know
Minnesota hospitals challenge Blue Cross policy shifting services to ASCs
Regent Surgical Health, Conformis partner to cut ASC joint replacement costs  

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