American Society of Regional Anesthesia and Pain Medicine May 2017 - 8
for patients enrolled in the TJA PSH at UCI Health. The explicit
strategies utilized in the program throughout the perioperative
continuum to curtail repeat admissions after hospital discharge are
outlined in a separate case report.35
Using the "burning platform" business lexicon,36,37 it has been
said that the current healthcare landscape is at a crossroads.
Paradigms that hasten surgical recovery3 are gaining much
momentum, fulfilling the Institute for Healthcare's proposed triple
aim of improving the experience of care, improving the health of
populations, and reducing per capita costs.38 The BPCI initiative is
a transparent strategy that is currently being utilized by CMS to
clarify if episode based payment can translate to "higher quality,
more coordinated care, at a lower cost to Medicare."1 Early results
have demonstrated that there is indeed significant potential for
cost savings and improved care quality with the application of
collective ("bundled") fiscal models.1-5 In a dynamic landscape21
where value added contribution to patient care is anticipated to be
financially endorsed, it is prudent to integrate clinical opportunities
that parallel favorable patient outcomes. An expansion in scope of
practice throughout the perioperative continuum, via paradigms
such as ERAS and PSH, is one such means to enhance care quality
while also preparing anesthesiologists for bundled pay.
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19. Bozic KJ, Ward L, Vail TP, Maze M. Bundled payments in total joint arthroplasty:
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20. Siracuse BL, Chamberlain RS. A preoperative scale for determining surgical
readmission risk after total hip replacement. JAMA Surg. 2016;151(8):E1-E9.
21. Szokol JW, Stead S. The changing anesthesia economic landscape: emergence
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American Society of Regional Anesthesia and Pain Medicine
2017
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