The Centers for Medicare and Medicaid will require over 800 hospitals nationwide to participate in a 5-year bundled payments test for hip and knee replacements. Under the test, hospitals will be financially responsible for the quality of care from surgery through 90 days post-discharge, including all related Medicare Parts A and B services. The goal is to reduce readmissions and ensure coordinated care, thereby reducing expenses. Because of the financial risk, hospitals will likely only refer patients to high-rated skilled nursing facilities.

1. BUNDLED PAYMENTS:
WHAT YOU NEED
TO KNOW
This Slideshare is from Community First Solutions.
This slide share
first appeared on
www.YourTimeBC.org

2. The Centers for Medicare and Medicaid
(CMS) is planning to require more than 800
hospitals nationwide to participate in a 5-year
long test of bundled payments for hip and
knee replacements.
The proposed test will hold hospitals
accountable for the quality of care they deliver
to Medicare beneficiaries receiving these
procedures from surgery through recovery.

3. WHAT DOES THIS MEAN?
Hospitals will bear the financial risk beginning at hospital
admission and lasting until 90 days after discharge, to include
all-related care covered under Medicare Parts A and B.
• Procedure
• Inpatient stay
• Hospital care
• Post-acute care
• Physical Therapy
• Provider services

4. WHY HIP AND KNEE
REPLACEMENTS?
1. Hip and Knee replacements are among the most
common procedures received by Medicare beneficiaries.
2. These procedures are almost always paired with
physical therapy.
3. Currently, the quality and cost of hip and knee
replacements vary greatly among providers.

5. THE GOAL
1. Reduce the amount of hospital
readmissions and ensure beneficiaries get
the coordinated care that they need by
providing incentives for hospitals to work
with physicians, home health agencies and
nursing facilities.
2. Reduce expenses

6. WHAT IT MEANS FOR SKILLED
NURSING FACILITIES
Because hospitals will take on all financial risk
for the surgery and outcome, they are likely
to only refer patients to the highest rated
skilled nursing facilities.

7. Colonial’s two Continuing Care Retirement Communities,
Berkeley Square and Westover, have both maintained
their 5-star rating through toughened CMS standards. In
addition, as part of Community First Solutions, Colonial
is in a unique position to manage successful outcomes
throughout recovery.
From transitioning clients through skilled rehabilitative
nursing care, to in-home physical therapy, to maintaining
their independence at state-of-the art wellness centers,
Community First offers a variety of long-term solutions
to meet the dynamic needs of older adults.
Community First Solutions is the non-profit parent company of Colonial,
Community Behavioral Health, Community First Pharmacy and Partners in Prime.