Medicare Bundled Payment Explanation and Disclosure

Under Medicare guidelines, St. Clair Hospital is “bundling” charges associated with hip and knee replacement procedures.

By bundling, hospitals are reimbursed an inclusive cost for these types of procedures. Instead of reimbursing hospitals, physicians, nursing homes, home care, and therapies each separately, Medicare is paying one set amount for the entire “episode of care” for 90 days, beginning the first day of admission. St. Clair is responsible for working with all the providers involved to make sure the most effective care with the best outcome is provided.

This does not affect your coverage as a patient. Medicare benefits for patients remain unchanged; there is no change to your covered services under this initiative.

As always, you as a patient have a right to choose your care and your providers. However, this is a Medicare requirement for all hospitals in 67 major metropolitan areas around the country. Our area includes every facility in the following counties: Allegheny: Armstrong: Beaver; Butler; Fayette; Washington; and Westmoreland.

St. Clair Hospital has entered into financial arrangements with the collaborating health care providers who are engaged in care redesign with the Hospital and who may furnish health care services to you during your episode of care. Under these agreements, St. Clair Hospital may share payments received from Medicare as a result of reduced episode spending and Hospital internal cost savings with collaborating providers. St. Clair Hospital may also share financial accountability for increased episode spending with collaborating providers and suppliers.

The following list includes health care providers and suppliers who have established a collaborator agreement with St. Clair Hospital in order to share in financial rewards and/or losses in the Comprehensive Care for Joint replacement (CJR) model:

• Gerson Florez, MD
  1050 Bower Hill Road, Suite 105
  Pittsburgh, PA 15243

• Derrick Fluhme, MD
  2000 Oxford Drive, Suite 211
  Bethel Park, PA 15102

• Richard Mitchell, MD
  1050 Bower Hill Road, Suite 105
  Pittsburgh, PA 15243

• Brett Perricelli, MD
  2000 Oxford Drive, Suite 211
  Bethel Park, PA 15102

• Shaka Walker, MD
  1050 Bower Hill Road, Suite 105
  Pittsburgh, PA 15243