Referral and reimbursement policies
About bundled care
Bundled care is an integrated funding model designed to promote integration in health care delivery, drive high-quality, efficient care, and improve patient outcomes and experience.
Patient eligibility
Bundle providers may request funding from Sunnybrook Health Sciences Centre (SHSC) when their patients meet the following criteria:
- The patient had a primary knee or hip replacement surgery and was discharged from SHSC on or after April 1, 2018; or
- The patient had a shoulder arthroplasty or bilateral hip/knee replacement surgery and was discharged from SHSC on or after April 1, 2019;
- The patient meets Quality Based Procedure (QBP) eligibility criteria.
Please note:
- The bundled care model excludes hip, knee and bilateral revision surgeries.
- WSIB claims do not apply to the bundled care model.
Terms of referral acceptance
By accepting a referral for an approved Sunnybrook bundled care patient, the service provider is agreeing to provide care according to the Rehabilitative Care Alliance (RCA) Best Practices Guidelines.
NACRS Lite Reporting
NACRS Clinic Lite is used to capture information on post-acute ambulatory rehabilitative service utilization by Bundled Care patients. In accordance with Ministry of Health directive, Sunnybrook requires that all post-acute rehabilitative care funded by Sunnybrook be reported into NACRS Clinic Lite. Please see https://www.cihi.ca/en/nacrs-clinic-lite for further information from CIHI.
Pricing
Effective January 1, 2021, Sunnybrook Health Sciences Centre per-case prices for each type of rehabilitation care provided by bundle providers are as follows:
Bundle |
Outpatient Rehab | Inpatient Rehab |
Home Care |
|---|---|---|---|
Hip |
$312 |
$6,517 |
$682.51 |
Knee |
$312 |
$6,095 |
$618.45 |
Bilateral |
$407 |
$4,897 |
$534.30 |
Shoulder – Total/Hemi |
$486 |
$8,872 |
$864 |
Shoulder – Reverse |
$486 |
$15,305 |
$906 |
These prices:
- Apply to the full scope of services provided for the episode of care (e.g. per patient, not per visit);
- Are non-negotiable and align with sample prices provided by the Ministry of Health;
- Invoices for any other amount will not be processed and will be required to be resubmitted to the prices noted above; and
- Are subject to change, notification will be provided.
Sunnybrook Health Sciences Centre’s fiscal year (April 1, 2019 – March 31, 2020) per-case prices for each type of rehabilitation care provided by bundle providers are as follows:
Bundle |
Outpatient Rehab | Inpatient Rehab |
Home Care |
|---|---|---|---|
Hip |
$299.52 |
$6,539 |
$682.51 |
Knee |
$249.60 |
$6,076 |
$618.45 |
Bilateral |
$312 |
$4,499 |
$534.30 |
Shoulder – Total/Hemi |
$312 |
$8,301 |
$864 |
Shoulder – Reverse |
$312 |
$13,621 |
$906 |
Reimbursment process and policies
In order to proceed with payment, please complete the following:
1) Bundle provider to complete the patient data form and return back to bundledcare@sunnybrook.ca for data verification.
- To ensure patient data safety, please password protect the file.
- Please send password in a separate email with the same subject line.
2) SHSC will verify the patient data and confirm via email within 10 days patient eligibility for bundled care funding.
3) Once confirmed, bundle provider will issue an invoice to SHSC for the services and will include the following information:
- HST Registration Number
- Facility Number
Additionally, please note:
- SHSC will not process any invoices until the bundle provider has confirmed that the treatment is complete (noted through a confirmed discharge date).
- All invoices and EFTs must be received electronically.
- Invoices should be sent a maximum once per month for all patients that completed rehabilitation.
- Invoices must be received no later than six (6) months after rehab completion.
Download forms
Contact information
Email: bundledcare@sunnybrook.ca
