Archive Orthopedic Surgery 2019

Get On Board With Bundled Payments

You can deliver quality outcomes at lower costs - and profit, too - by managing every aspect of an episode of care.

Joe Paone

Joe Paone

BIO

LEG UP
PAYING DIVIDENDS Managers of bundled payments allocate and distribute portions of a single fee to other providers along the continuum of care.

It's time to embrace the bundled payment, a single fee negotiated with insurers in exchange for managing every aspect of patient care from the moment cases are scheduled to 90 days post-op. There's risk involved (you pay the costs that exceed the bundled amount), but also plenty of opportunity for reward (you share in the savings realized by delivering quality care for less than the agreed upon fee).

Excelsior Orthopedics in Amherst, N.Y., began bundling for total joints 4 years ago, and has thrived since implementing the risk-sharing reimbursement model. "It lends itself well to total joints, because they're predictable, repeatable surgeries with good outcomes," says Excelsior CEO David Uba, MBA.

Payers were responsive to Excelsior's bundled payment proposals because the cost savings were so obvious, according to Mr. Uba. He says the site-of-service differential, just getting the cases out of the hospital, gave his group the ability to save local payers about 30% to 35% per episode of care.

"Bundled payments have allowed us to control the flow of not only patient outcomes and quality, but also the opportunity to control the dollar," explains Mr. Uba. "No longer does the insurance company assign value along the spectrum of care. We do."

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