Earlier this month, Midwest Orthopaedics at Rush began offering patients bundled payments for orthopedic care. The Chicago-based orthopedic practice is the first academic practice and is among the first orthopedic groups in the nation to offer patients these kinds of bundled payments.
"Healthcare is changing dramatically. Many patients are locked into high deductibles or captured network plans," said Nikhil Verma, MD, a professor and director of clinical research in the sports medicine section at Rush University Medical Center, and an orthopedic surgeon at Midwest Orthopaedics at Rush. "Part of the problem in the healthcare system is you can't figure out the cost of the treatment process until a patient goes through it."
To help patients navigate the complex healthcare system, Midwest Orthopaedic at Rush implemented cash-pay bundled payment systems to help patients in captured networks or high deductible plans find quality, affordable healthcare. With the bundle, the practice makes the prices transparent and does not come with hidden fees.
Here are five key points:
1. Midwest Orthopaedics at Rush offers the program for the following five procedures:
• ACL repair: $10,800
• Hip arthroscopy: $13,250
• Knee arthroscopy: $5,000
• Rotator cuff repair: $11,300
• Shoulder arthroscopy: $10,000
"We looked at five of our top outpatient arthroscopic procedures and came up with transparent prices for our patients," Dr. Verma explained. "We published those prices so patients have easy access to what the cost may be if they need to pay out-of-pocket or for companies that are self-insured."
2. The packaged price includes surgeon fees, facility fees, anesthesia fees, supplies and implants and any uncomplicated follow-up care. The initial fee does not cover discharge and complications following the procedure. The five procedures covered in the bundle carry minimal risk of complications, according to Dr. Verma, which is the primary reason Midwest Orthopaedics at Rush offers the bundle for those five outpatient procedures.
3. Services patients may need to seek outside of practice's bundle include:
• MRI or X-rays
• Postoperative rehabilitation
• Home health services
• Physical therapy,
• Durable medical equipment
• Postoperative medication
4. The price packages may be well suited for patients who travel from around the world to obtain care from Midwest Orthopaedic at Rush's orthopedic specialists, as Rush University Medical Center ranked sixth on U.S. News & World Report's "Best Hospitals for Adult Orthopedics" list.
"This bundle is for those patients who want a choice in healthcare and want to see one of our physicians based on quality and experience," Dr. Verma said. "We get a lot of patients coming to us from other parts of the country or other countries. This helps them understand the pricing."
The bundle does not include travel expenses, overnight stays or specialist consultations prior to surgery to determine medical clearance.
5. In the package, the prices are non-negotiable and payment is expected in full when Midwest providers render the services. The patients pay Midwest Orthopaedics at Rush directly and third parties or insurance companies won't be billed for services in the program.
"To launch the bundle, we really benefited from the fact that we are a private group and able to move quickly to respond to market demands. However, we were also able to partner with Rush who was willing to be involved in the endeavor and put the bundle together," Dr. Verma said. "Our impetus is to make the highest quality of healthcare affordable and transparent to the consumer."
More articles on practice management:
5 key trends in how physicians choose their practice location
Santa Rosa Orthopaedics turns 70: 4 points
Raleigh Orthopaedic Clinic names Sean M. McNally CEO: 4 points