4 thoughts on bundled payments for spine & orthopedic practices

Practice Management

Bundled payment programs are becoming increasingly popular among spine and orthopedic practices. These programs aim to help improve care coordination, clinical outcomes and patient experience.

At the Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference, June 14 to 16, in Chicago, a panel of ambulatory surgery center and physician practice administrators discussed their experiences with bundled payments.

The panel included:

• Steven Mash, MD, musculoskeletal medical director at Downers Grove, Ill.-based DuPage Medical Group
• Richard Kube, MD, spine surgeon and founder/owner of Prairie Spine and Pain Institute in Peoria, Ill.
• Teresa Copeland, director of managed care at Knoxville (Tenn.) Orthopaedic Surgery Center
• Jeff Zigler, senior director of market access, health economics and reimbursement for Zimmer Biomet

Here are four key thoughts from the panel:

Dr. Kube: "In general, orthopedics and spine have been opportune for bundles. If you are looking at bundles, you need to know your stress points and cost points, and we understand, as orthopedic and spine surgeons, our procedures, the imaging [and so on]. If you have an ASC, you have a lot more control to drive that bundle. The bundling I've done, we go direct to employers and patient populations… It's really been about the education. Educate people about this type of model, and it is possible and can restore value to the system."

Ms. Copeland: "Education, both internal and external, [is key]. The thing that stands out is most often it wasn't the medical issues that were the roadblocks but the social issues — the sick husband at home while the wife needed a total joint replacement. That's the conversation that has to happen in the education [about the model]. It can all be figured out, but we often don't know about those roadblocks [and that deters people from getting the procedure]."

Dr. Mash: "Doctors respond to peer-pressure and to data, and when you put the data up in an un-blinded way, it moves them. You have to give the doctors feedback. The doctors most adamant they couldn't do [the procedure] in a [certain] way found they could do it [that way]. We've also used a predictive analytics program from the beginning. Everyone involved with the patient can see where the patient is along the pathway. We are now managing 4,000 cases a year with one case manager using this technology."

Mr. Zigler: "I am surprised by how difficult it is for the average surgery center to sit down with a [big payer] network like Blue Cross. I think it's getting better. You can contract more regularly with a Cigna or Aetna now, but you have some [data] to send to the payers. It's been more uphill than I thought given we've talked about bundled payments for seven years."




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