Gain sharing in bundled payment TJA: Is it the way forward?

As health-care costs continue upon a meteoric rise, the Center for Medicare and Medicaid Services has developed a number of strategies designed to curb spending and at the same time incentivize the delivery of high quality care. Joint replacement has been a specific area of interest because of the volume of medicare patients seeking arthroplasty. The introduction of the Bundled Payment for Care Improvement initiative has placed the onus on hospital systems to continueto deliver quality care at lower costs. In an effort to do so, hospitals are beginning to engage physicians in their efforts by offering them financial incentive for keeping costs low—astrategy known as gain sharing. In this paper, we will review the history of gain sharing, the ethics surrounding it, and strategies for implementing a successful partnership between physicians and hospitals that works to eliminate excess spending without compromising patient care.