Alternative payment models: From bundled payments for care improvement and comprehensive care for joint replacement to the future?

Since the passage of the Patient Protection and Affordable Care Act (PPACA), the Centers for Medicare and Medicaid Services (CMS) has been mandated to transform from a passive consumer to an active purchaser of healthcare. The goal of this article is to report on the various bundle payment initiatives [Acute Care Episode Demonstration Project (ACE-DP), Bundle Payment for Care Improvement (BPCI), and Comprehensive Care for Joint Replacement (CJR)] sanctioned by CMS, and how these innovative reimbursement systems may affect orthopedic practice. The authors will also speculate on future reimbursement systems and how they may be integrated with big data principles to further enhance the quality and efficiency of orthopedic care.