KHSC Bundled Care - Elective Hip or Knee Replacement

 

About Bundled Care

In 2015, the Ministry of Health and Long-Term Care (MOHLTC) launched bundled care, an integrated funding model, to promote greater integration in health care delivery; drive high-quality, efficient care; and improve patient outcomes and experiences.

Since April 2018, Kingston Health Sciences Centre (KHSC) has been providing bundled care for elective hip and knee replacement surgeries. KHSC receives a single payment to cover all the care needs of an individual patient’s full spectrum of care. As a bundle holder, KHSC helps the integration of care between hospitals and community services, and is responsible for making sure payment is provided to qualifying partner and non-partner organizations that offer care related to surgical recovery, including inpatient, outpatient, and homecare rehabilitation.

 

Partners

KHSC has entered into formal agreements with two bundled care partners that currently provide care to a high-volume of patients:

  • Providence Care Centre
  • South East Local Health Integration Network

 

Non-Partners

KHSC also works with non-partners at the request of patients and after referral from KHSC to provide bundled care. Non-partners include:

  • organizations that provide Ontario government-funded homecare services
  • any Ontario hospital-operated rehab unit
  • any Ontario government-funded outpatient rehab provider such as publicly funded physiotherapy clinics

 

Funding Eligibility

Bundled care partners and non-partners may request funding from KHSC when their patients meet the following criteria:

  • The patient had an elective unilateral hip or knee replacement surgery at KHSC on or after April 1, 2018; and
  • The patient meets OHIP eligibility criteria; and
  • The patient’s primary diagnosis meets MOHLTC Quality-based Procedures (QBP) criteria for elective unilateral hip or elective unilateral knee replacement surgery. KHSC uses a thorough and audited review process to determine if QBP criteria have been met. Any requests for the reasons why a case did not meet criteria cannot be provided.

 

Pricing

KHSC’s fiscal year (April 1, 2018 to March 31, 2019) per-case prices for each type of rehabilitation care provided by non-partners are as follows:

  • Outpatient: Total Knee Arthroplasty (TKA) - $250 and Total Hip Arthroplasty (THA) - $300
  • Inpatient: TKA - $5,590 and THA - $6,184
  • Home care: TKA - $620 and THA - $685

These prices:

  • apply to the full scope of services provided for the episode of care (not per visit)
  • are non-negotiable and align with the sample prices provided by the MOHLTC
  • are applicable for qualifying QBP unilateral hip and unilateral knee replacement surgeries completed between April 1, 2018 to March 31, 2019
  • are subject to change, and notification will be provided if changes are made

Please note: KHSC will not make payments above and beyond the bundle QBP funding envelope allocated for hip and knee bundled care from the MOHLTC.

 

Payment Requests

In order for partners and non-partners to access KHSC’s Payment Request Portal and receive more information about invoicing, reporting and requesting payment, please complete and return the Network Access Request Form. Once you have been given access, please visit the Payment Request Portal, and use these instructions to find out what forms need to be completed and when.

 

Submission Timelines

The portal includes the Initiation of Care Template forms, which KHSC requires partners and non-partners to submit in order to determine QBP eligibility. In order to ensure accuracy of KHSC financial records for our March 31, 2019 fiscal reporting, we require that these Initiation of Care forms are submitted through our portal no later than Thursday, April 26, 2019. Failure to submit by this deadline may result in nonpayment for services if the total QBP funding allocation has been exhausted.

 

Contact

If you have general questions related to KHSC’s role as a bundle holder, please contact Tom Hart, Director of Patient Access, Flow and Clinical Resources at Thomas.Hart@kingstonhsc.ca or 613-549-6666 ext. 4106.