Infirmary Has Significant Success In Medicare Bundled Payment for Care Improvement Initiative

Infirmary Has Significant Success In Medicare Bundled Payment for Care Improvement Initiative


More than 500 primary joint replacement surgeries were performed for Medicare patients at CHI St. Vincent Infirmary between Oct. 1, 2013 and Sept. 30, 2014. In that time CHI St. Vincent Infirmary successfully achieved significant savings in Medicare costs as a result of the partnership with the Centers for Medicare & Medicaid Services (CMS) Bundled Payments for Care Improvement Initiative (BPCI). The exact savings are expected to be reported by CMS when the initiative officially closes in 2018.

“CHI St. Vincent Infirmary volunteered for the Initiative, requiring us to be accountable for the quality of care delivered to Medicare patients having hip or knee replacement surgery. As a result, CMS allowed us to share in the savings because of the high quality of care and the lower cost. If that had not been the outcome - high quality and lower cost - we would have been required to repay Medicare for a portion spent on the care. This program truly aligns incentives for patients, physicians, hospitals, and CMS,” said Kevin Cullinan, CHI St. Vincent Market Director of Orthopaedics.

The BPCI is designed to provide better care, spend health care dollars more wisely and make people healthier. It builds on measurable goals and a timeline toward paying providers based on the quality, rather than the quantity of care. Hospitals and physicians have an incentive to work together to deliver the best care possible, because the two share the savings. Three physicians, who perform joint replacement surgeries at CHI St. Vincent Infirmary, received a share.

The arrangement between CMS and CHI St. Vincent Infirmary is a retrospective bundled payment. Medicare continues to make fee-for-service payments, then actual expenditures are reconciled against a target price for an episode of care for joint replacement. Care includes the inpatient stay in an acute care hospital, acute care after the patient is discharged and all related services up to 90 days after the patient leaves the hospital. 

“We work with physicians and other providers to make sure our patients get coordinated care and the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. In addition to the savings, data show that Medicare patients who had joint replacement surgery at CHI St. Vincent Infirmary received better care, improved coordination of care during their hospital stay and had fewer readmissions after they were discharged,” Cullinan said.

While recovering at home, patients can call a hotline, specifically for them. A registered nurse, working with a surgeon, answers questions and provides assistance. In addition, before surgery, patients attend Joint Academy to educate them about the surgery and help them understand what they can expect during recovery. “The education before surgery and having a healthcare provider available all day every day have resulted in fewer patients needing inpatient post-acute care, all while readmissions have decreased,” Cullinan said.

CHI St. Vincent Infirmary is the first of four hospitals within the CHI St. Vincent network in Arkansas to participate in the BPCI. CHI St. Vincent Hot Springs will begin participating in a similar program known as CJR, or Comprehensive Care for Joint Replacements, April 1, 2016. “The experience of our physicians, clinicians and staff at the Infirmary will be beneficial for our patients and colleagues at Hot Springs. Even though CJR is a mandatory program, there are more similarities than differences to BPCI. CMS data show that hospitals with more experience in the program perform better over time. By sharing our experience we expect to have the same positive outcome at Hot Springs,” Cullinan said.

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