Blue Cross to accept one payment for knee replacements

Jan. 17, 2013 @ 06:52 PM

Blue Cross and Blue Shield of North Carolina announced Thursday a deal with Duke University Health System that will allow the insurer’s customers to make one payment covering care for a period before, during and after knee replacement surgery.

The “bundled payment” would cover treatment in the pre-surgical period 30 days before hospitalization, the surgery and follow-up care within 90 days after the patient is discharged from the hospital, according to a news release from the insurer.

The program became effective Jan. 1, and is available to the insurer’s customers when knee replacements are done by Duke University doctors at Duke University Hospital or Durham Regional Hospital, which is part of the system.

“These kinds of efforts in new care models that help drive greater efficiencies while increasing quality will become more and more prevalent and clearly represent the future of health care delivery,” Dr. Victor J. Dzau, chancellor for health affairs at Duke University, and CEO of Duke University Health System, said in the release.

The bundled payment arrangement does not apply to Blue Cross’ customers under the FEP and Blue Medicare plans, the release states.

In addition to the partnership with Duke, Blue Cross and Blue Shield of North Carolina also recently announced a deal with private North Carolina Specialty Hospital in Durham that would allow customers to make a single payment for surgery.

That deal was for the insurer’s customers to make one payment to Triangle Orthopaedic Associates when knee replacement surgery is performed at the hospital. Triangle Orthopaedic Associates jointly owns the specialty hospital.

The bundled payment was to include: pre-operative tests and office visits within 30 days of the procedure, appointments and care during the hospital stay, and related outpatient care for 90 days after surgery.