CMS Proposes to Bundle Payments for Hip & Knee Replacements

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed new payment model that would bundle payment to acute care hospitals for hip and knee replacement surgery. Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods. In 2013, there were more than 400,000 inpatient primary procedures costing more than $7 billion for hospitalization alone. The average Medicare expenditure for surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas.

Under this proposed model, the hospital in which the hip or knee replacement takes place would be accountable for the costs and quality of care from the time of the surgery through 90 days after—what’s called an “episode” of care. This model would be in 75 geographic areas throughout the country and most hospitals in those regions would be required participate. To view the fact sheet, click HERE.