Ontario Roles out Bundled Care Models for Hip and Knee Replacement

The vision for the health care system in Ontario is a higher performing, better connected, more integrated and patient-centred system for patients and care providers. Funding through bundled payments serves as a way to support improved patient continuity through the care continuum and incent high quality outcomes, while monitoring costs.

Bundled models provide a single payment for an episode of care across multiple settings and  providers.  With bundled care: 

  • Care is integrated to create seamless transitions and ease a patient’s move from hospital to home 
  • Providers share risks and gains, incenting collaboration and integration 
  • Providers are accountable for quality outcomes (value‐based care)

St. Joseph’s Health System’s Integrated Comprehensive Care Demonstration Project (ICCP) pioneered the bundled care model in Ontario.  Subsequently, over the past 3 years 6 pilots of bundled care have been engaged across the province.  As a result of the success of these projects, the Ministry of Health has committed to a voluntary expansion of standardized bundled payments in 2017/18 for hip and knee replacement surgeries.

Why hip and knee replacement?

The ministry is initiating the scale and spread of bundled care with hip and knee replacement  surgery because it is a clearly defined episode of care, with accepted best practices and a  jurisdictional precedent for bundling. 

What is being offered? 

The bundled hip and knee replacement QBP is an extension of the existing surgical QBP into a  bundled model. This bundle will bridge a patient’s episode of care from the acute phase to  post‐acute phase.  Each LHIN is being offered the opportunity to identify cross‐provider teams to participate in  a  voluntary year of bundled care for hip and knee replacement surgery.  Teams will begin working together in November 2017 and the bundled price will be  introduced on April 1, 2018, for the full FY18/19 fiscal year. 

Pricing approaches

The following considerations were used in the development of the price: 

  • The bundle price is built so that every surgical patient  can receive post‐acute  rehabilitative care, according to best practice;
  • The price will exclude readmissions and revisions; outcomes will be monitored and  tracked to inform future bundle scope;
  • The bundled price for hips is $9,630.841 and the bundled price for knees is $8,626.691; Fiscal year 2018/19 is an introductory year. The price will evolve over time as data gaps are  filled.
Implications for Occupational Therapists 

Occupational therapists are involved in hip and knee replacement bundles of care in various programs across the province.  As a model of choice for implementation, OTs should familiarize their structure and programs.  Find out what's happening in your LHIN.

Best practices for hip and knee replacement are found in:

Learn more about the MOHLTC vision and work relating to models of bundled care here.​

How are occupational therapists involved in your region?  Keep OSOT informed at osot@osot.on.ca.​  Why not network with OTs across the province who provide services to clients undergoing hip and knee replacements?  OSOT's online networking tool - Find-a-Colleague - can help you find others who share your practice focus.