No regrets about dropping bundled payments, Rothman Orthopaedics president says


Although Philadelphia-based Rothman Orthopaedics has eliminated bundled payments, its president, Alexander Vaccaro, MD, PhD, said using them is still worth it for some practices.

He reflected on that decision a year later and told Becker's Spine Review how he thinks other practices should look at the payments.

Question: At a Becker's event last year, you announced that Rothman was dropping out of bundled payments. Has your view of bundled payments changed over the past year?

Dr. Alexander Vaccaro: My view of bundle payments has not changed. It is an effective way of developing patient-facing value-based healthcare decisions. The innate problem, however, is the intrinsic “race to the bottom” effect of bundled payments that reduces long-term reimbursements to important stakeholders in the process. This, unfortunately, misaligns incentives to participate. I have not seen any material changes in the approach from CMS that would make continued participation in the BPCI program compelling. At Rothman, we are proud to deliver the highest quality care, and affordability is part of our mission statement. We believe a commitment to increased value in healthcare should be rewarded for the long-term, not just in the short term for initial savings.

Q: What would you advise other practices to consider when it comes to bundled payments?

AV: Every practice circumstance is unique. I think it is extremely important to engage in the process of bundled payments to understand where a particular group is in their value proposition to patient-facing care. The ability to manage risk in reimbursement requires sophisticated data analytics, alignment among all stakeholders and the operational resources to navigate patients through evidence-based care pathways.

Q: What other value-based models do you see developing in orthopedics?

AV: As practices become more sophisticated in their ability to manage risk, there will be a natural shift toward capturing premium dollars in the form of sub-capitation agreements. These arrangements may be with health systems, Accountable Care Organizations, large primary care groups or any entity that is involved with Medicare Direct contracting. Considerations for carve-outs, such as for spine procedures where there is greater variability, would need to be factored in to ensure financial viability and maintain high quality patient outcomes.

Q: How will the payer market in Florida influence Rothman's operations?

AV: We will focus on delivering evidence-based cost-effective care to local communities in the Florida market which is easily accessible so that we can exceed the expectations of our patients.

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