What is Bundled Care?
Bundled care is a service delivery and funding model that is designed to promote greater integration in health care delivery, drive high-quality, efficient care and improve patient outcomes and experience. In a bundled care approach, a group of health care providers receives a single payment to cover all the care needs of an individual patient’s full spectrum of care for a specific health issue.
In Ontario, the bundled care model of has been applied to hip replacement and knee replacement surgeries. St. Joseph’s Healthcare Hamilton was the first health care team to trial the bundled care model in September 2015. In 2018/2019 the bundled care model was rolled out to 24 health care teams in the province. These 24 health care teams provided bundled care for more than 20,000 hip and knee surgical patients, representing more than 60% of the hip replacement and knee replacement surgeries in the province during that period. Currently there are over 50 health care teams in the province of Ontario with more being added each year.
The health care organization such as a hospital or network of hospitals that administers the health care team is designated as the “bundled holder”. Bundle holders are funded on a per surgery basis and are responsible for organizing care for a patient from the time surgery is decided until their physiotherapy is completed. The bundled holder is also responsible for transferring funds to service providers or team members who deliver services within the scope of the bundle. Team members include: The surgeon and anesthesiologist, nurses, pharmacist, social worker, community care, physiotherapists and occupational therapists.
For the fiscal year 2021, the bundled funding for unilateral hip replacement surgery is $7512.00 and the bundled funding for unilateral knee replacement surgery is $7025.00. These prices apply to the full scope of services provided for the episode of care, are non-negotiable and are subject to change over time. From this bundled funding, $312.00 or approximately 4% of the funding is available for community based physiotherapy. The orthopedic surgeon receives approximately $1200.00 and the anesthetist receives approximately $800.00 for each surgery performed. These numbers represent approximately 17% and 11% of the total funding bundle respectively. The remaining funding covers the cost of overhead and other health care team members such as nursing, medical resident, etc.
While the goal of bundled care is to provide seamless care for patients requiring total joint replacement, there is room for improvement. As the bundled care program was rolling out across the province, the COVID-19 pandemic presented a whole new series of challenges. Patient communication that would have been done in person was completed virtually or not at all. Hospital staff did not fully understand the funding model and information that was provided to patients was not always consistent or accurate. We have seen bundle holder communication to patients improve over the last year and patients calling for physiotherapy are more familiar with the bundled care service delivery and funding model than they were in early 2022.
For patients seeking post knee replacement physiotherapy or post hip replacement physiotherapy pre-planning is essential. It is imperative that you begin physiotherapy about a week after surgery and your surgeon will ask you to have physiotherapy organized prior to your surgery. The earlier the patient calls to organize physiotherapy to easier it is for Physio In Motion to accommodate their request. Bundled care will provide up to $312.00 or $39.00 per visit for up to 8 visits for community based physiotherapy. If a patient also has extended health insurance both bundled care and extended health insurance can be used to cover the cost of treatment. Physio In Motion provides direct billing to all bundle holders and to most extended health insurers to minimize the out of pocket expense for our patients.
If you have questions about bundled care or post knee replacement physiotherapy or post hip replacement physiotherapy please do not hesitate to contact Physio In Motion; we would be pleased to speak with you.