Bundled Care in Elective Total Joint Replacement: Payment Models in Sweden, Canada, and the United States

Rising health-care expenditures and payer dissatisfaction with traditional models of reimbursement have driven an interest in alternative payment model initiatives.Bundled payments, an alternative payment model, have been introduced for total joint replacement in Sweden, the United States, and Canada to help to curb costs, with varying degrees of success.Outpatient total knee arthroplasty and total hip arthroplasty are becoming increasingly common and provide value for patients and payers, but have negatively impacted providers participating in bundled payment models due to considerable losses and decreased reimbursement.A fine balance exists between achieving cost savings for payers and enticing participation by providers in bundled payment models.The design of each model is key to payer, provider, and patient satisfaction and should feature comprehensive coverage for a full cycle of care whether it is in the inpatient or outpatient setting, is linked to quality and patient-reported outcomes, features appropriate risk adjustment, and sets limits on responsibility for unrelated complications and extreme outlier events.