Medicare Joint Replacement Program

What is the Bundled Payments for Care Improvement (BPCI) Program?

Medicare created the Bundled Payments for Care Improvement (BPCI) program to evaluate the effectiveness of providing one type of value-based payment. The BPCI program seeks to encourage your doctors, hospitals and other health care providers to work more closely together, during a given episode of care, to improve the quality of care while also lowering the cost of that care to Medicare.

Ventura Orthopedics is Participating in the BPCI Program

Ventura Orthopedics is participating in the Bundled Payments for Care Improvement program Model 2 for hip and knee joint replacements. This participation means that Ventura Orthopedics’ physicians have voluntarily agreed to a new payment arrangement with the goal of providing patients with higher quality, more efficient, more coordinated care that should lead to improved recovery time. Participation in this initiative does not affect any patient’s access to care nor restrict the patient’s freedom to choose healthcare providers.

Ventura Orthopedics’ physicians are working closely with hospitals and other healthcare providers who will care for patients during surgery and through the recovery period. By working together, healthcare providers plan and manage processes to provide more efficient, high quality care for each patient undergoing treatment and recovery. These changes in care management and coordination are expected to lower the cost of care to Medicare, but your costs won’t go up due to these changes in care. Hospitals, doctors and other providers who provide care during and following a hospital stay may be rewarded for providing patients with high quality, more coordinated care. Medicare will monitor your care to make sure you and others get high quality care.

As a Medicare Beneficiary, You May Be a Patient in the BPCI Program

If you are a Medicare beneficiary and are a patient of Ventura Orthopedics, you may be a patient in the BPCI program. If this is the case, you will receive formal notice of this fact and details about what you should expect. For example, a designated Case Manager will be assigned to you to walk you through the course of treatment for your hip or knee replacement surgery. The Case Manager will begin working with you and your family from the time your surgery date is scheduled through the entire rehabilitation period, generally 90 days after you have been discharged from the hospital.

The Case Manager will accommodate and support your needs by:

• Helping you understand the pre-admission process as well as the preparation for surgery
• Reviewing with you what you can expect before surgery, during hospitalization and at discharge from the hospital
• Explaining the recovery process and helping you develop a discharge plan ahead of time for optimal recovery
• Providing ongoing care coordination throughout the post-surgical rehabilitation period to ensure that transitions between care providers is seamless and that appropriate high quality care is provided to allow you to return to normal daily activities
• Keeping your personal health information confidential and protecting your privacy under the HIPAA Privacy Rule (Health Insurance Portability and Accountability Act)

Get More Information

We are happy to answer any questions you have about the BPCI program and your potential participation. For more information about Ventura Orthopedics’ participation in the Bundled Payments Model 2 program, please contact Jill Platt, Nurse Case Manager, at 805.320.4831, or by email at jillp@venturaortho.com.

If you have questions or want more information about Bundled Payments Model 2 from Medicare, you can call 1-800-MEDICARE. You can also find additional information at www.innovation.cms.gov.