Bundled Payment Initiative for Hip Fracture Arthroplasty Patients: One Institution's Experience

Objectives: To analyze the effectiveness of a Bundled Payments for Care Improvement (BPCI) initiative at a large urban medical center for hip fracture patients included in the bundle payment program with respect to improving patient outcomes and reducing cost. Design: Retrospective cohort. Setting: Single Academic Institution. Patients/Participants: Patients discharged with the diagnosisrelated group codes 469-470 performed for hip fractures between July 2011 and September 2014 were evaluated. A BPCI initiative focused on optimizing care coordination, patient education, expectations, and minimizing postacute facility and resource utilization was initiated in October 2013. Patient outcomes before the introduction of the BPCI initiative were compared with those who participated in the initiative. Intervention: Application of BPCI principles. Main Outcome Measures: Length of stay, location of discharge, readmission within 90 days, and 90-day episode of care costs. Results: Sixty-one patients received care before the initiative, and 44 patients were treated with the initiative. The mean length of stay decreased from 6.8 to 5.3 days and the percentage of patients discharged home increased by nearly 10% with the introduction of the BPCI initiative (6.6% vs. 15.9%). There was a 13.1% reduction in total 90-day episode of care cost ($ 57,546 vs. $ 49,993, P = 0.210) on introduction of the initiative. There was no significant difference in readmission rate between the 2 cohorts. Conclusions: This study demonstrates the success of one such program for hip fracture arthroplasty patients aimed at care coordination and minimizing postacute hospitalization facility care both with respect to improved patient outcomes and substantial cost reduction.