and managed services firm based in Pella, Iowa. “A lot of value-based programs

concern hospitals and family prac- tices, but the one that will probably affect ASCs the most in the short term is bundled payments,” he says. “Spe- cifically, we are seeing more consid- eration given by ASCs and payers to bundled payments for joint replace- ment procedures.” Tufts says that if an ASC negotiates

Value-Based Care in Today’s ASC Market

Surgery centers should seize the opportunity BY ROBERT KURTZ


egardless of the changes that will be made to the US health care system in the coming years, at least one thing seems to be certain, says Gregory Horner, MD: Value-based care is here to stay. Horner, an ASCA Board member, works as a managing partner at HealthPoint Ambulatory Surgery Company, an ASC manage- ment and development company in Newbury Park, California. “The federal government and soci-

ety at large have embraced the concept of value-based care,” he says. “ASCs and their physicians would be wise to do so as well. In speaking with many ASC physicians, value-based care can be perceived as a bad concept, as it is often associated with something tan- tamount to capitation, but that is not necessarily the case.”

16 ASC FOCUS APRIL 2017 Value-based care, Horner says,

boils down to achieving the quadru- ple aim of health care: better health, improving patient experiences, reduc- ing cost and improving the work life of health care clinicians and staff. “ASCs are already the low-cost provider, so they should start looking for ways to take advantage of the trend toward value-based care by proving even bet- ter value across these four metrics.”

Consideration for Bundled Payment While payers are already pushing for- ward with a number of value-based initiatives, they have been slow to penetrate the ASC market, says Jim Tufts, leadership solutions team lead at ICE Technologies, a health care information technology consulting

a bundled payment for a total joint pro- cedure, it would likely be tasked with distributing the payment to the pro- viders of services through that proce- dure’s entire episode of care. “Service providers would include surgeons, anesthesia, post-operative care and physical therapists,” he says. “Instead of everyone acting in their own silo, an ASC would need to work upstream and downstream with the different providers and settings involved in the episode of care and determine the appropriate fees for services.”

Successful Execution One example of an ASC that is suc- cessfully participating in a bun- dled payment is the surgery center of the Orthopedic & Sports Institute of the Fox Valley in Appleton, Wiscon- sin. In 2011, the organization nego- tiated its first bundled payments for hip and knee replacement procedures with payers, says Chief Executive Offi- cer Curt Kubiak. As of January 2017, the practice had negotiated more than 70 bundled payments with payers and self-insured employers, covering about 80 percent of the orthopedic and spine care provided by the organization. “We are single-specialty focused on musculoskeletal services, so our administrative costs are a fraction of what it would take to run a multi-dis- ciplinary larger facility, like a hospi- tal,” he says. “The ASC environment offers a lower-cost alternative than a standard inpatient operating room

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