Implementation of Bundled Payment Initiatives for Total Joint Arthroplasty: Decreasing Cost and Increasing Quality.

Although the Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January 2013, it may be years before the data can determine if the BPCI Initiative enhances value without decreasing quality. Private insurers have implemented other bundled payment arrangements for the delivery of total joint arthroplasty in a variety of practice settings. It is important for surgeons to review the early results of the BPCI Initiative and other bundled payment arrangements to understand the challenges and benefits of healthcare delivery systems with respect to total joint arthroplasty. In addition, surgeons should understand methods of cost control and quality improvement to determine the effect of the BPCI Initiative on the value-quality equation with respect to total joint arthroplasty.

Bundled payment initiatives for Medicare and non-Medicare total joint arthroplasty patients at a community hospital: bundles in the real world.

In the setting of current United States healthcare reform, bundled payment initiatives and episode of care payment models for total joint arthroplasty (TJA) have become increasingly common. The following is a review of our results and experience in a community hospital with bundled payment initiatives for both non-Medicare and Medicare TJA patients since 2011. We have successfully decreased the cost of the TJA episode of care in comparison to our historical averages prior to 2011. This cost-reduction has primarily been achieved through decreased length of inpatient stay, increased discharge to home rather than to skilled nursing or inpatient rehabilitation facilities, reduction in implant cost, improvement in readmission rate and migration of cases to lower cost sites of service.

Supported endograft limb occlusion likely occurring secondary to hip arthroplasty.

PURPOSE: To report an acute endograft limb occlusion immediately subsequent to a total hip replacement. CASE REPORT: A 62-year-old man underwent successful placement of a bifurcated stent-graft for a 5-cm abdominal aortic aneurysm (AAA). Surveillance imaging documented a satisfactory outcome and no defects in the stent-graft. Three months after the endograft procedure, he underwent left total hip arthroplasty, at which time the left endograft limb acutely thrombosed. He was successfully treated with thrombectomy and dilation/stenting of the thrombosed graft limb. CONCLUSIONS: Patients with aortoiliac stent-grafts need careful surveillance around the time of a procedure that may require extreme manipulation of the pelvis and hips. Even fully supported, widely patent endograft limbs may be vulnerable to acute thrombosis in this setting.