Bundled payments for joint replacement target a key quality measure: patient satisfaction

Ironically, the editorial “Let Medicare test ways to save money” was published the day before the Centers for Medicare and Medicaid Services launched one of its most significant experiments to cut costs, improve quality of care, and improve value in health care. On April 1, CMS introduced its first mandatory bundled-payment initiative, focusing on one of health care’s most expensive and common procedures: total hip and knee joint replacement. Each year there are more than 1 million of these surgeries, at a total cost of more than $50.5 billion. Medicare is projected to save $343 million through this new program.

Of particular significance to patients, the nearly 800 hospitals participating in this experiment will track and report quality, cost, and, for the first time, patient satisfaction measures. These patient-reported outcomes are a critical new way of indicating success, or failure, from the patient’s perspective.

The ultimate measure of whether this surgery is successful is whether the patient has less pain and more mobility. CMS proposes that patient-reported outcomes be measured nine to 12 months after surgery. In contrast, currently, total hip and knee joint replacement is a “success” if the implant doesn’t fail. Patients are rarely asked for their own assessment of their health, pain, or disability. But who better to tell us how they feel before, and after, treatment?


This Medicare test holds great promise not only for saving money, but for engaging patients and using their feedback to improve care in ways that can make a difference in millions of individuals’ lives.

Dr. David Ayers

Dr. Patricia Franklin


The writers are in the department of orthopedics and physical rehabilitation at the University of Massachusetts Medical School.