The Clinical, Operational, and Financial Components of a Successful Bundled Payment Program for Lower Extremity Total Joint Replacement

SummaryThe Bundled Payment for Care Improvement Model 2 for major joint replacement of the lower extremity and subsequent Comprehensive Care for Joint Replacement model have demonstrated net savings to the Centers for Medicare and Medicaid Services (CMS) without diminution of care quality. Between 2014 and 2019, Hospital for Special Surgery treated 19,694 patients in these programs and received $29.2 million in reconciliation payments, the largest in the United States, while at the same time maintaining among the highest care quality in the country. The hospital estimates that savings to CMS totaled $23.9 million. Key elements to success included meaningful financial incentives with broad flexibility in how they could be used and access to the full claims experience of patients in the program. Alignment of payer and provider interests is essential for successful value-based care delivery.