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Prometheus Payment Model: Application to Hip and Knee Replacement Surgery

  • Symposium: ABJS Carl T. Brighton Workshop on Health Policy Issues in Orthopaedic Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

The Prometheus Payment Model offers a potential solution to the failings of the current fee-for-service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical services that are informed by evidence and/or expert opinion as well as empirical data analysis, payment based on the severity of patients, and allowances for potentially avoidable complications (PACs) and other provider-specific variations in payer costs. We outline the methods and findings of the hip and knee arthroplasty ECRs with an emphasis on PACs. Of the 2076 commercially insured patients undergoing hip arthroplasty in our study, PAC costs totaled $7.8 million (14% of total costs; n = 699 index PAC stays). Similarly, PAC costs were $12.7 million (14% of total costs; n = 897 index PAC stays) for 3403 patients undergoing knee arthroplasty. By holding the providers clinically and financially responsible for PACs, and by segmenting and quantifying the type of PACs generated during and after the procedure, the Prometheus model creates an opportunity for providers to focus on the reduction of PACs, including readmissions, making the data actionable and turn the waste related to PAC costs into potential savings.

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Acknowledgments

We thank the Robert Wood Johnson Foundation for their grant and their support in making this study possible.

Author information

Authors and Affiliations

  1. Prometheus Payment®, Bridges to Excellence, 10326 Sandy Lane, Munster, IN, 46321, USA

    Amita Rastogi MD, MHA

  2. Brandeis University, Waltham, MA, USA

    Beth A. Mohr MS

  3. Masspro, Waltham, MA, USA

    Jeffery O. Williams BS

  4. Statworks, Canton, MA, USA

    Mah-Jabeen Soobader MPH, PhD

  5. Bridges to Excellence, Newtown, CT, USA

    Francois de Brantes MS, MBA

Authors
  1. Amita Rastogi MD, MHA
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  2. Beth A. Mohr MS
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  3. Jeffery O. Williams BS
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  4. Mah-Jabeen Soobader MPH, PhD
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  5. Francois de Brantes MS, MBA
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Corresponding author

Correspondence to Amita Rastogi MD, MHA.

Additional information

Bridges to Excellence is funded by the Robert Wood Johnson Foundation.

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Rastogi, A., Mohr, B.A., Williams, J.O. et al. Prometheus Payment Model: Application to Hip and Knee Replacement Surgery. Clin Orthop Relat Res 467, 2587–2597 (2009). https://doi.org/10.1007/s11999-009-0942-3

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  • DOI: https://doi.org/10.1007/s11999-009-0942-3

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