McLawhorn Alexander S, Buller Leonard T
Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Department of Orthopedic Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA.
Curr Rev Musculoskelet Med. 2017 Sep;10(3):370-377. doi: 10.1007/s12178-017-9423-6.
The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA).
From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control. Early results of bundled payments are promising, but preserving access to care for patients with high comorbidity burdens and those requiring more complex care is a lingering concern. Hospitals, regardless of current participation in bundled payments, should develop care pathways for TJA to maximize efficiency and patient safety.
本综述旨在评估有关全关节置换术（TJA）捆绑支付报销模式的文献。
从经济角度来看，TJA具有成本效益，但对医疗保险和医疗补助服务中心（CMS）而言是一项巨大开支。从历史上看，按服务收费的支付模式导致成本和质量差异很大。CMS于2012年推出了改善护理捆绑支付（BPCI），随后在2016年推出了关节置换综合护理（CJR）报销模式，旨在通过成本控制提高质量，从CMS和患者的角度提升TJA的价值。捆绑支付的早期结果很有前景，但如何确保合并症负担高的患者以及需要更复杂护理的患者能够获得医疗服务仍是一个长期问题。无论目前是否参与捆绑支付，医院都应制定TJA护理路径，以实现效率最大化和患者安全。
