Bundled payments pose a challenge, opportunities remain in orthopedics: Dr. Paul Slosar

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Bundled payments haven't worked for some orthopedic surgeons because they aren't providing enough savings, according to Paul Slosar, MD.

Dr. Slosar, chief medical officer of Episode Solutions in Nashville, Tenn., told Becker's why bundled payments don't always work, and offered another option for savings.

Note: This response was edited for clarity.

Question: Why are so many orthopedic groups dropping bundled payments?

Dr. Paul Slosar: Bundled payments for orthopedic surgeons under the CMS BPCI-A program have continued to evolve as savings have been realized. Unfortunately, several policies enacted over the past couple of years have negatively impacted many experienced surgeon participants with lower target prices, combined service line groups and missed eligibility opportunities for the surgeons performing cases at the ASC. The surgeons with longer histories in the program, especially those that have demonstrated improved clinical efficiencies and cost savings, are paradoxically the ones who now struggle to find any significant savings opportunities remaining.

There are, however, still meaningful opportunities for many other surgeons to realize savings by streamlining post-acute care services, selecting the best site of service, and engaging with experts experienced in BPCI-A navigation. With the program now officially extending through 2025, this is a new window of opportunity for surgeons who have not been engaged to join BPCI-A as they may have more upside opportunity and will be better prepared to participate in future risk arrangements, including possible mandatory bundles which may be on the CMS horizon.

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