CMS Implements Bundled Payments for Hip and Knee Replacements; WSHA Provides Resources

November 18, 2015

On November 16, the Centers for Medicare & Medicaid Services (CMS) finalized its rule concerning payment of hip and knee replacements for hospitals in selected regions.  The new program goes into effect April 1, 2016 and will affect hospitals in the Seattle-Tacoma-Bellevue and Portland-Vancouver-Hillsboro metropolitan service areas that provide hip and knee replacement surgery.  The program makes hospitals financially responsible for the cost of services related to knee and hip replacement surgeries from admission through 90 days’ post-discharge, including the post-acute care.  The final rule provides a three-month delay to the effective date, and stratifies replacements due to hip fractures from other hip replacements, based on the higher rehabilitation costs associated with replacements due to fractures.

In conjunction with the final rule, CMS and the Office of the Inspector General jointly announced  waivers of certain existing restrictions and penalties which currently prevent hospitals  from entering into agreements with post-acute providers such as skilled nursing facilities.

WSHA, through our relationship with DataGen, will be providing a summary of the rule, and we are also providing an opportunity to get impact data using 2014 claims data.  For $3,500, hospitals can purchase a full data set showing Medicare claims expenses for all services within the 90-day bundle period.  This can help determine how their hospital will be impacted and where opportunities exist to reduce costs.  (Andrew Busz)


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