HARRIS MEYER / January 24, 2020
Analyses of CMS data on Medicare’s largest bundled-payment demonstration suggest providers may have reached the limit of their ability to streamline joint replacement procedures.
While the joint replacement bundle for hips and knees has been one of the most popular of Medicare’s Bundled Payment for Care Improvement Advanced program, providers are shifting to bundles for medical and chronic conditions like sepsis and chronic obstructive pulmonary disease. 
On total joints, participants already may have done all they could to make care more cost-effective by reducing use of post-acute skilled nursing care, said Dr. Amol Navathe, assistant professor of health policy at University of Pennsylvania who studies bundled payment models.
For physician groups, the bundle for back and neck except spinal fusion replaced total joint replacement of the hip and knee as the mostly commonly selected episode—with 34% choosing back and neck, while selection of the joint replacement bundle plunged to 22% from 77%.
The target pricing on the joint replacement bundle often is moving lower, making it harder for providers to be financially successful with it, said Keely Macmillan, senior vice president of policy for Archway Health.