Bundled Funding for Primary Arthroplasty

Bundled funding strategy

As of April 1, 2018, the Ministry of Health and Long-Term Care (MOHLTC) implemented a bundled funding strategy whereby a single payment is given to a provider to cover the costs of an episode of health care across multiple settings and providers.

Sinai Health as the bundle holder, is responsible for transferring funds to service providers who deliver the in-scope services (i.e. post-op outpatient rehabilitation services for qualifying elective unilateral primary hip or knee replacement Quality Based Procedures performed at Sinai Health). Out of scope patients under this program include (but not limited to): patients from out of province; bilateral hip and knee replacements; emergency hip fracture surgery; and surgeries at institutions other than Sinai Health.

Treatment

Acceptance of referral requires the receiving facility to provide post-operative rehabilitation services in accordance with the Quality-Based Procedures Clinical Handbook for Primary Hip and Knee Replacement developed by Health Quality Ontario and MOHLTC.

The number, frequency and duration of visits offered for post-operative rehabilitation must be necessary and reasonable for the treatment of the total hip or total knee replacement post-surgical condition, as determined by the treating practitioner using his/her clinical judgment of the patient’s individual need and evidence-based best practices.

Patients will be discharged once the therapeutic objectives identified in the treatment plan have been achieved, or when any reasonably equivalent gains could be achieved through exercise, or when no further gains are likely to be achieved from continuing the rehabilitation services.

Reimbursement for services

Sinai Health will reimburse Publically-Funded Community Physiotherapy Clinics as per the Bundled Care model at a ceiling of $312 (hip or knee) per episode of care, on confirmed discharge.

LHINs will be reimbursed at $682.51 for home care for hip patients, and $618.45 for knee patients.

All other clinics should bill private insurance as appropriate.

Upon completion of the course of rehabilitation and discharge from your clinic please provide the information noted below by email to [email protected] for purpose of payment.

• Patient name
• Gender
• Health card number
• Date of surgery, if known
• Indicate if surgery was hip or knee arthroplasty
• Clinic name
• Contact name
• Ambulatory care facility number #
• Contact telephone number and email address
• Pre and post treatment lower extremity functional scale (LEFS) scores
• Confirmation that the Clinic has submitted NACRS Clinic Lite Outpatient reporting through eFile/web entry tool to the Canadian Institute for Health Information (CIHI)

For billing inquiries or other questions please contact: [email protected].