Bundled Payments and Joint Replacement

Joe Cantlupe, for HealthLeaders Media , June 13, 2012
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Success key No. 4: Data registry
The Connecticut Joint Replacement Institute uses its joint-replacement registry—with data on thousands of patients—to evaluate clinical protocols for improved outcomes for its total hip and knee patients. "That data from the registry was crucial while implementing our bundled payment program," says Steven Schutzer, MD, medical director.

The Connecticut Joint Replacement Institute at the 617-bed Saint Francis Hospital and Medical Center in Hartford, Conn., is an integrated program focused on implementing standardized best practices for hip- and knee-replacement surgery.

"The registry provides our rocket fuel; all of our outcomes data is derived from the registry, and this enables us to track our cost and clinical outcomes," Schutzer says.

The registry is important because it facilitates continuous process improvement projects, he says. The bundled payment program is known as the Step Ahead Plan and includes a package of goods and services for a single price, with an optional warranty. It is a collaborative effort among the Connecticut Joint Replacement Surgeons LLC, the Woodland Anesthesiology Associates, and the Saint Francis Hospital and Medical Center, Schutzer says. The program's warranty will be provided to some patients covering postoperative surgical-site complications.

"Without registry data, creating bundled payments or other risk-sharing, value-based healthcare products would not be possible," he says. "Under our bundled payment arrangement, the revenues are allocated to the three providers of the bundle based on the providers' cost for delivering services."

Schutzer says the institute, which opened in 2007, uses the data to monitor and review best practices and clinical protocols. The Step Ahead Plan is governed by a joint governing committee involving representatives from all three parties.

"Clean, credible data is a very powerful and persuasive tool," he says, because it is one the stakeholders—both physicians and administrators—"have difficulty refuting."

This article appears in the June 2012 issue of HealthLeaders magazine.

Reprint HLR0612-8

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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