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Alternative Payment Models in Total Joint Arthroplasty An Orthopaedic Surgeon’s Perspective on Performance and Logistics


  • 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.

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

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JBJS Reviews: June 2019 – Volume 7 – Issue 6 – p e5doi: 10.2106/JBJS.RVW.18.00126