New Hip and Knee Replacement Pay Program (written by Biloine Young @ OTW)
Vastly different charges for the same procedure—often performed by the same surgeon in the same city—are prompting doctors and hospitals to experiment with new ways to charge for their services. According to a report in the Los Angeles Times, several California hospitals will begin using bundled fees, which include both facility and physician fees, when billing for hip and knee replacements.
Proponents say charging a predetermined fee for standard surgical procedures would eliminate surprises for patients and would help control costs. Hospitals participating in the pilot program, which is being overseen by the non-profit Integrated Healthcare Association, include Cedars-Sinai Medical Center and UCLA hospitals, both in Los Angeles, and Hoag Memorial Hospital Presbyterian in Newport Beach.
Beginning in August the hospitals plan to charge lump-sum fees for hip and knee replacements. The bundled fee is planned to cover nearly all aspects of the medical treatment related to the procedures, such as physician fees, implant costs, imaging services and other tests, for up to 90 days after the surgery. The program mirrors Medicare’s bundled payment pilot programs, but will involve commercial insurers and only the two procedures.
AEtna, Blue Shield of California, CIGNA and HealthNet have agreed to participate.
The federal government is testing similar “bundled” payments for the Medicare program in Colorado, Texas, New Mexico and Oklahoma. “The idea is to provide an incentive for doctors and hospitals to sit down together to figure out the best way to care for their patients,” said Weslie Kary of the nonprofit Integrated Healthcare Association, which is heading up the California experiment. Specific charges for the California program have not yet been set.