About Bundled Care
In 2015, the Ministry of Health 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. In April 2019, KHSC started providing bundled care for shoulder surgeries (total, hemi and reverse). 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.
KHSC has been approved by the Ministry of Health (MOH) to participate in a bundled care expansion, which will include patients who have had a stroke or Coronary Artery Bypass Graft (CABG) surgery. The expansion date has not yet been released.
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
- Ontario Health@Home
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 or hospital-based outpatient rehab clinic
- any Ontario government-funded community 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, or shoulder surgery on or after April 1, 2019; Bilateral joint on or after April 1, 2022 and
- The patient meets OHIP eligibility criteria; and
- The patient’s primary diagnosis meets MOH Quality-based Procedures (QBP) criteria for elective unilateral hip, elective unilateral knee replacement surgery, shoulder surgery or bilateral joint replacement. 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; and
- All post-acute ambulatory rehabilitative care must report into NACRS Clinic Lite. Providers must obtain a master number from the MOH to report into NACRS Clinic Lite.
Pricing
KHSC’s fiscal year (April 1, 2023 to March 31, 2024) per-case prices for each type of rehabilitation care provided by non-partners are as follows:
- Outpatient Rehabilitation: Total Knee Arthroplasty (TKA) - $312 I Total Hip Arthroplasty (THA) - $312 I Shoulder Total/Hemi Arthroplasty (STHA) - $486 I Shoulder Reverse Arthroplasty (SRA) - $486 I Bilateral Joint Arthroplasty (BJA) - $407
- Inpatient Rehabilitation: TKA - $6,095 I THA - $6,517 I STHA - $8,872 I SRA - $15,305 I BJA - $4,897
- Home care Rehabilitation: TKA - $618 I THA - $683 I STHA - $864 I SRA - $906 I BJA - $534
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 QBP funding envelope allocated to KHSC for bundled care
- are applicable for qualifying QBP unilateral hip and unilateral knee replacement surgeries bilateral joint replacement surgeries and shoulder (total, hemi, reverse) surgeries
- 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 bundled care from the MOH.
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 the accuracy of KHSC financial records for our March 31, 2024 fiscal reporting, we require that these Initiation of Care forms are submitted through our portal no later than Wednesday, April 17, 2024. Failure to submit by this deadline may result in nonpayment for services if the total QBP funding allocation has been exhausted.
Contact
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