Perioperative management strategies to improve outcomes and reduce cost during an episode of care.

Total joint arthroplasty is a successful procedure with measurable and clear outcomes that have historically required a complex array of resources to deliver. The resulting expense burden has placed this procedure at the center of many payment reform efforts, including bundled payments. The orthopedic surgeon, through his orders and known preferences, determines the resource consumption during an episode of care. Strategies to better optimize the medical and social determinants of care prior to surgery can pay off in improved outcomes at reduced cost. Physician leadership is critical to altering the culture and achieving the desired results.