The annual meeting of the American Academy of Orthopaedic Surgeon kicks off Tuesday and in advance of it, a new analyst report shows that when it comes to bundled care, surgeons are being cautious to do joint replacement procedures.
The Comprehensive Care for Joint Replacement (CJR) rolled out to several areas nationwide last April, in a bid to control costs related to hip and knee replacement. Through this, Medicare gives hospitals a lump sum amount for a 90-day period involving each patient’s procedure. If the cost of the procedure and associated care is below that amount, hospitals come out on top. If not, hospitals have to stomach the extra expenditure and repay Medicare although that is not required in the first year of the five-year-program.
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“There will be no responsibility to repay Medicare in Performance Year 1,” the report confirmed. “However, responsibility will be capped at 5% of target prices in Performance Year 2, 10% in Year 3, and 20% in Years 4 and 5.”
The goal is to pay for good outcomes. At the 2016 annual meeting of the AAOS, there were worries about how there might be reticence among physicians to treat certain kinds of patients.
And a report from Brandon Henry, an analyst with RBC Capital Markets who surveyed surgeons ahead of the AAOS meeting found that surgeons are denying or delaying the procedure on average to 14 percent more of their hip/knee patients. Of the 51 surgeons surveyed, 56 percent, a majority, said they are part of the CJR program.
So who are these patients that are being denied the procedure or being asked to delay it?
Surgeons answered in a variety of ways, but there’s a clear indication of who surgeons feel are high-risk patients who are likely to have poor outcomes after the procedure: They are those who are morbidly obese, heavy smokers, with poorly controlled diabetes.
Aside from these, patients who have multiple comorbidities, as well as those surgeons deem to be at a higher risk of infection are also being denied.
Meanwhile, paradoxically, Henry noted that even though the trend to deny or delay is present, he has not noticed it reflected in lower volume of hip/knee procedures. Indeed, surgeons say there is interest in clearing a backlog in the next six to 12 months.
The CJR program is not the first bundled payment program that the ortho industry has seen although it is not a voluntary program given that it is in effect in 67 metropolitan statistical areas. Its previous version, Bundled Payments for Care Improvement (BPCI) was optional.
Photo: BrynDonaldson, Getty Images
