Starting today, Medicare is changing the way it will pay Toledo-area hospitals for joint replacements.

The federal government, as a part of the Affordable Care Act, is trying to drive down the price for such replacements, which are costly and among the most common procedures for senior citizens.

In 2014, more than 400,000 Medicare patients received a hip or knee replacement — costing more than $7 billion for the hospitalizations alone, according to the U.S. Department of Health and Human Services.

The Toledo Metropolitan Statistical Area, which includes Lucas, Wood, and Fulton counties, and 67 other metro areas have a new mandate from Medicare. A five-year pilot program will track joint-replacement surgery patients for three months and combine the costs for surgery and any associated care into a single payment.

Federal officials call this a “target price” or “bundled payments.” Hospitals that hold costs below the target price can keep a portion of the savings. Hospitals that don’t must repay the government.

For the Toledo metro area, the target payment for hip and knee replacements from Medicare is currently $28,658, according to ProMedica officials.

The model isn’t new to Medicare, but until now, the programs have been voluntary. This is the first mandatory program, and it’s projected to save Medicare $343 million over the five-year pilot period.

Even if a patient goes into a rehabilitation center after surgery, gets an infection, and is readmitted to the hospital within 90 days, the hospital will be held responsible for the increased cost of caring for that patient, local health officials said.

“At the end of the year, the government is going to look at that whole 90-day period and whatever that whole amount was for any services that the patient uses, from that day of surgery until 90 days out,” said Shannon Holley, associate vice president of patient care and operations at ProMedica.

“They’ll shore that up and whatever is over or under, the hospital will either be paying back the government for that difference or you could get reimbursed if you fall under what they are going to pay you,” Ms. Holley added.

There is a 5 percent cap on what hospitals are reimbursed or what they have to pay back to Medicare during the first year of the pilot program, she said.

About 56 percent of ProMedica’s and nearly 41 percent of Mercy Health’s patients have either Medicare or a Medicare Managed health insurance plan.

“This is only the beginning” of mandates from the Centers for Medicare & Medicaid Services, said Norine Wasielewski, vice president of clinical integration for Mercy Health.

Each year of the pilot program, the percentage that hospitals will be expected to reimburse the government will increase. Health officials are also preparing for bundled payments from the government to become the norm for nearly every procedure.

“Bundling is the future,” Ms. Wasielewski said.

Putting hospitals in the position of managing the patient’s quality of care and costs three months after the surgery has forced closer collaboration between hospitals and local rehabilitation centers, Ms. Holley said.

Mercy is also working more closely with skilled nursing facilities to make sure their nurses are better educated and patients are safe, Ms. Wasielewski said. She also said Mercy has made suggestions to some rehabilitation facilities that they increase the amount of therapy that joint-replacement patients receive.

Rehabs have become “the step-down unit today,” for hospitals, she said.

Added Ms. Holley: “This really incentivizes the hospitals to provide better care for the patients because you want to prevent those readmissions and prevent the complications and you want to have the patients prepared for surgery.”

The local hospital systems are also spending more time with patients before surgery, making sure they are healthy and have information about how to better care for themselves after the procedure.

ProMedica has classes for joint-replacement patients called Preoperation University.

“The other thing we are really pushing is preoperatively getting people fit for surgery,” said Dr. Karl Beer, ProMedica orthopedic surgeon.

Patients who give up smoking, get their diabetes or high blood pressure under control, and who lose weight if they are obese before surgery have better results. he said.

“People that are just out of control, we have to delay their surgery until they do these things. This is elective surgery. It’s not like we have to do your hip or knee replacement,” Dr. Beer said.

Contact Marlene Harris-Taylor at: mtaylor@theblade.com, 419-724-6091, or on Twitter @marlenetaylor48.

First Published April 1, 2016, 4:00 a.m.