AS I SEE IT


Paving the Way for Bundled Payments Overcoming barriers from concept to execution BY CHRIS BISHOP


While movement toward shared savings, shared risk and shared responsi- bility is paving the way for


bundled payments,


early adopters in the practice and ASC market have found that moving from concept to execution is extremely complicated. No matter how many bundles are put together, the next one created will still be complicated, and uniquely so, because the components change every time, the participants are different, the patient population is different and the risk factors are dif- ferent. The good news is that, today, we know a lot more about what all the pieces of the puzzle should look like and can assemble them much more efficiently than in the past to achieve better results.


The time to be involved with bun- dled payments has come.


According to research conducted by ORC International and commissioned by McKesson (orcinternational.com/ news-item/value-based-payment-hits- tipping-point/), bundled payments are the fastest growing payment type with projected growth of 6 percent over the next 5 years. This would place bundled payments at 17 percent of all medical payment types by the year 2022. For


organizations that are still


in the research or concept phase of bundles, it is likely time to acceler- ate efforts to transition to execution. To do so successfully, physicians and ASCs need to understand how to close the knowledge gap, how to negotiate a bundle and how to iden- tify key stakeholders.


tunities for improvement, benefits programs, payer risk models and more. Making just one mistake can wipe away the entire value of the contract and put a practice or facil- ity at risk.


Closing the Knowledge Gap Historically, hospitals have been the entities with the knowledge and resources to navigate this challeng- ing


environment. Innovative sur-


geons and ASCs, however, are begin- ning to recognize that they are in an optimal position to take a leadership role in this process and truly benefit from the shift away from fee-for-ser- vice to value-based payments. The most important thing to recognize for practices and ASCs that are used to negotiating fee-for- service agreements is that bundles are something entirely different. It is easy to assume that all that is needed to create a successful bun- dle is to understand physician fees, facility fees and anesthesia costs. In reality, success requires regulatory knowledge, pricing data from all potential providers (e.g., home care, imaging and physical therapy) and an in-depth understanding of options regarding care pathways, participat- ing surgeons’ care pathways, oppor-


From payer organizations and hos- pitals to privately insured employers and privately held surgery centers, everyone has a unique approach to a bundled structure. Flexibility is key to finding the right program for the partners involved. To close the knowledge gap, prac- tices and centers need to understand what data is necessary to structure a program and, maybe more impor- tantly, where to find it. Practices and ASCs rarely have the resources to tackle this on their own. While they know what they charge, other fees such as anesthesia, facility fees or home health might be unknown. On top of normal fees, what about vari- ations if there are complications? How do you calculate a retrospective episode of care against a target price and trust that the numbers the payer are sending you are correct? Additionally, the kind of per- son with the expertise to success- fully organize this sort of program is unique. It needs to be someone who can ignore decades of experi- ence practicing health care one way and conceptualize an entirely new process. Can they think big and out- side the box? Can they understand what each partner needs out of the program to be successful? Can they inspire the entire partnership? Most importantly, can they take all those


The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion. 10 ASC FOCUS JANUARY 2019 | ascfocus.org


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