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Alternative Payment Models in Total Joint Arthroplasty

An Orthopaedic Surgeon’s Perspective on Performance and Logistics

Feng, James E. MD1; Padilla, Jorge A. MD1; Gabor, Jonathan A. BS1; Cizmic, Zlatan MD1,2; Novikov, David BS1; Anoushiravani, Afshin A. MD1,3; Bosco, Joseph A. MD1; Iorio, Richard MD4; Meftah, Morteza MD1

doi: 10.2106/JBJS.RVW.18.00126
Review Articles with Critical Analysis Component

  • » The U.S. Patient Protection and Affordable Care Act (Affordable Care Act or “Obamacare”) represents a comprehensive initiative to improve health insurance coverage, affordability, and access, while minimizing health-care spending and improving upon the quality of care provided.
  • » The U.S. Center for Medicare & Medicaid Innovation, one of the important components of the Affordable Care Act, has developed new innovative payment and service delivery models, commonly referred to as alternative payment models, to reduce health-care expenditures.
  • » Alternative payment models have undergone several iterations over the past decade, including the Acute Care Episode (ACE) demonstration, the Bundled Payments for Care Improvement (BPCI) initiative, the BPCI Advanced initiative, and the Comprehensive Care for Joint Replacement (CJR) program.
  • » The goal of this article was to review the logistics, performance, and limitations of these 4 alternative payment models and to discuss what the future of health-care reimbursements may hold.

1Department of Orthopedic Surgery, NYU Langone Health, New York, NY

2Department of Orthopaedic Surgery, Ascension Providence Hospital, Southfield, Michigan

3Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York

4Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

E-mail address for M. Meftah:

Investigation performed at the Department of Orthopedic Surgery, NYU Langone Health, New York, NY

Disclosure: There was no source of external funding for this study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and “yes” to indicate that the author had other relationships or activities that could be perceived to influence, or have the potential to influence, what was written in this work (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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