Medicare Proposes Bundled Payment for Joint Replacement

By Alpha Lillstrom and Jerry Connolly

The Centers for Medicare & Medicaid Services (CMS) is proposing, through the rulemaking process, a new model to support better and more efficient care for beneficiaries undergoing the most common inpatient surgeries for Medicare beneficiaries: hip and knee replacements. This model, referred to as the Comprehensive Care for Joint Replacement Model, would test bundled payment and quality measurement for an episode of care associated with total hip arthroplasty (THA) and total knee arthroplasty (TKA) to encourage hospitals, physicians, and post–acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery.1

Hip and knee replacements (also called lower extremity joint replacements or LEJR) are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods. In 2013, there were more than 400,000 inpatient primary procedures costing more than $7 billion for hospitalization alone.

Medicare Proposes Bundled Payment for Joint Replacement – Table Data

Metro Areas for Bundling Demo

MSA MSA Title Counties
10420 Akron, OH Portage County, Summit County
10740 Albuquerque, NM Bernalillo County, Sandoval County, Torrance County, Valencia County
11700 Asheville, NC Buncombe County, Haywood County, Henderson County, Madison County
12020 Athens-Clarke County, GA Clarke County, Madison County, Oconee County, Oglethorpe County
12420 Austin-Round Rock, TX Bastrop County, Caldwell County, Hays County, Travis County, Williamson County
13140 Beaumont-Port Arthur, TX Hardin County, Jefferson County, Newton County, Orange County
13900 Bismarck, ND Burleigh County, Morton County, Oliver County, Sioux County
14500 Boulder, CO Boulder County
15380 Buffalo-Cheektowaga-Niagara Falls, NY Erie County, Niagara County
16020 Cape Girardeau, MO-IL Alexander County, Bollinger County, Cape Girardeau County
16180 Carson City, NV Carson City
16740 Charlotte-Concord-Gastonia, NC-SC Cabarrus County, Gaston County, Iredell County, Lincoln County, Mecklenburg County, Rowan County, Union County, Chester County, Lancaster County, York County
17140 Cincinnati, OH-KY-IN Dearborn County, Ohio County, Union County, Boone County, Bracken County, Campbell County, Gallatin County, Grant County, Kenton County, Pendleton County, Brown County, Butler County, Clermont County, Hamilton County, Warren County
17820 Colorado Springs, CO El Paso County, Teller County
17860 Columbia, MO Boone County
18580 Corpus Christi, TX Aransas County, Nueces County, San Patricio County
19500 Decatur, IL Macon County
19740 Denver-Aurora-Lakewood, CO Adams County, Arapahoe County, Broomfield County, Clear Creek County, Denver County, Douglas County, Elbert County, Gilpin County, Jefferson County, Park County
20020 Dothan, AL Geneva County, Henry County, Houston County
20500 Durham-Chapel Hill, NC Chatham County, Durham County, Orange County, Person County
21780 Evansville, IN-KY Posey County, Vanderburgh County, Warrick County, Henderson County
22420 Flint, MI Genesee County
22500 Florence, SC Darlington County, Florence County
22660 Fort Collins, CO Larimer County
23540 Gainesville, FL Alachua County, Gilchrist County
23580 Gainesville, GA Hall County
24780 Greenville, NC Pitt County
25420 Harrisburg-Carlisle, PA Cumberland County, Dauphin County, Perry County
26300 Hot Springs, AR Garland County
26900 Indianapolis-Carmel-Anderson, IN Boone County, Brown County, Hamilton County, Hancock County, Hendricks County, Johnson County, Madison County, Marion County, Morgan County, Putnam County, Shelby County
28140 Kansas City, MO-KS Johnson County, Leavenworth County, Linn County, Miami County, Wyandotte County, Bates County, Caldwell County, Cass County, Clay County, Clinton County, Jackson County, Lafayette County, Platte County, Ray County
28660 Killeen-Temple, TX Bell County, Coryell County, Lampasas County
29820 Las Vegas-Henderson-Paradise, NV Clark County
30700 Lincoln, NE Lancaster County, Seward County
31080 Los Angeles-Long Beach-Anaheim, CA Orange County, Los Angeles County
31180 Lubbock, TX Crosby County, Lubbock County, Lynn County
31540 Madison, WI Columbia County, Dane County, Green County, Iowa County
32780 Medford, OR Jackson County
32820 Memphis, TN-MS-AR Crittenden County, Benton County, DeSoto County, Marshall County, Tate County, Tunica County, Fayette County, Shelby County, Tipton County
33100 Miami-Fort Lauderdale-West Palm Beach, FL Broward County, Miami-Dade County, Palm Beach County
33340 Milwaukee-Waukesha-West Allis, WI Milwaukee County, Ozaukee County, Washington County, Waukesha County
33700 Modesto, CA Stanislaus County
33740 Monroe, LA Ouachita Parish, Union Parish
33860 Montgomery, AL Autauga County, Elmore County, Lowndes County, Montgomery County
34940 Naples-Immokalee-Marco Island, FL Collier County
34980 Nashville-Davidson–Murfreesboro–Franklin, TN Cannon County, Cheatham County, Davidson County, Dickson County, Hickman County, Macon County, Maury County, Robertson County, Rutherford County, Smith County, Sumner County, Trousdale County, Williamson County, Wilson County
35300 New Haven-Milford, CT New Haven County
35380 New Orleans-Metairie, LA Jefferson Parish, Orleans Parish, Plaquemines Parish, St. Bernard Parish, St. Charles Parish, St. James Parish, St. John the Baptist Parish, St. Tammany Parish
35620 New York-Newark-Jersey City, NY-NJ-PA Dutchess County, Bergen County, Bronx County, Essex County, Hudson County, Hunterdon County, Kings County, Middlesex County, Monmouth County, Morris County, Nassau County, New York County, Ocean County, Orange County, Passaic County, Pike County, Putnam County, Queens County, Richmond County, Rockland County, Somerset County, Suffolk County, Sussex County, Union County, Westchester County
35980 Norwich-New London, CT New London County
36260 Ogden-Clearfield, UT Box Elder County, Davis County, Morgan County, Weber County
36420 Oklahoma City, OK Canadian County, Cleveland County, Grady County, Lincoln County, Logan County, McClain County, Oklahoma County
36740 Orlando-Kissimmee-Sanford, FL Lake County, Orange County, Osceola County, Seminole County
37860 Pensacola-Ferry Pass-Brent, FL Escambia County, Santa Rosa County
38300 Pittsburgh, PA Allegheny County, Armstrong County, Beaver County, Butler County, Fayette County, Washington County, Westmoreland County
38940 Port St. Lucie, FL Martin County, St. Lucie County
38900 Portland-Vancouver-Hillsboro, OR-WA Clackamas County, Columbia County, Multnomah County, Washington County, Yamhill County, Clark County, Skamania County
39340 Provo-Orem, UT Juab County, Utah County
39740 Reading, PA Berks County
40060 Richmond, VA Amelia County, Caroline County, Charles City County, Chesterfield County, Dinwiddie County, Goochland County, Hanover County, Henrico County, King William County, New Kent County, Powhatan County, Prince George County, Sussex County, Colonial Heights city, Hopewell city, Petersburg city, Richmond city
40420 Rockford, IL Boone County, Winnebago County
40980 Saginaw, MI Saginaw County
41860 San Francisco-Oakland-Hayward, CA Alameda County, Contra Costa County, San Francisco County, San Mateo County, Marin County
42660 Seattle-Tacoma-Bellevue, WA King County, Snohomish County, Pierce County
42680 Sebastian-Vero Beach, FL Indian River County
43780 South Bend-Mishawaka, IN-MI St. Joseph County, Cass County
41180 St. Louis, MO-IL Bond County, Calhoun County, Clinton County, Jersey County, Macoupin County, Madison County, Monroe County, St. Clair County, Franklin County, Jefferson County, Lincoln County, St. Charles County, St. Louis County, Warren County, St. Louis city
44420 Staunton-Waynesboro, VA Augusta County, Staunton city, Waynesboro city
45300 Tampa-St. Petersburg-Clearwater, FL Hernando County, Hillsborough County, Pasco County, Pinellas County
45780 Toledo, OH Fulton County, Lucas County, Wood County
45820 Topeka, KS Jackson County, Jefferson County, Osage County, Shawnee County, Wabaunsee County
46220 Tuscaloosa, AL Hale County, Pickens County, Tuscaloosa County
46340 Tyler, TX Smith County
47260 Virginia Beach-Norfolk-Newport News, VA-NC Currituck County, Gates County, Gloucester County, Isle of Wight County, James City County, Mathews County, York County, Chesapeake city, Hampton city, Newport News city, Norfolk city, Poquoson city, Portsmouth city, Suffolk city, Virginia Beach city, Williamsburg city
48620 Wichita, KS Butler County, Harvey County, Kingman County, Sedgwick County, Sumner County

The New Non-Niche


Physical therapists as health care professionals.

By Scott C. Spradling, certified administrator, and Carrie M. Hall, PT, MHS

Imagine thinking so far outside the box that you end up coming full circle and finding yourself smack in the middle of that same box. That idea, that hook, that niche that you have been trying to come up with—was right there all along: physical therapy, the new niche that is really a non-niche.

Plain and simple, a clinic that provides patient-centered focus with highly skilled practitioners who spend one-on-one time with patients and uses a lifespan primary care practitioner concept is the “non-niche.”

Niche is defined as “a place, employment, status, or activity for which a person or thing is best fitted.”1 By definition, the best niche for a physical therapist is not a specialty within the profession, it is the profession.

Never Fall Down


Promoting the quality and growth of therapeutic services in Cambodia.

By Patricia McCormick | Reviewed by Susan Nowell, PT, DPT

On April 17, 1975, the Communist Party of Kampuchea, otherwise known as the Khmer Rouge, took control of Cambodia, forcing over a million people to evacuate Phnom Penh and return to the countryside in a radical effort to instate a classless, primarily agrarian society. Khmer Rouge radicalization resulted in the brutal deprivation of basic human rights and the death of two million. Never Fall Down is a historical account of the afflictions facing the young Arn Chorn-Pond as he survived oppression and escaped death during the Khmer Rouge era in Cambodia.

The book, ghostwritten by Patricia McCormick, captures the atrocities of the period and the vulnerabilities of the young Cambodian as he is taken from innocent boyhood and his beloved family and put to work in the fields. Under the brutal Khmer Rouge regime, he is forced to work laboriously in the heat as he witnesses others dying from hunger, malaria, and exhaustion. In the midst of this massive genocide, the repercussions of the Vietnam War in Cambodia, Arn masters music to save his life.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.