All in Healthcare

There are a lot of bundled payment programs, but the best known one is the Center for Medicare and Medicaid Services’ (CMS) Comprehensive Care Joint Replacement (CJR) program. It’s complex, but Medicare essentially sets a target for the total cost of a hip or knee replacement (including the physician, hospital, and rehabilitation fees), and pays a bonus if costs are kept down and quality measures are met.

In the 15 years I have practiced obstetrics, I have been the surgical assistant on hundreds of cesarean deliveries that seemed to me, at the time, to be unnecessary, and I’ve been the surgeon of record for a handful of unnecessary cesarean deliveries myself. I know firsthand how difficult it is for physicians, nurses, policy makers, and administrators, all of whom are well aware that the United States has a cesarean epidemic, to wrestle with it.