AS I SEE IT
big new concepts and put them into action? Taking an entirely different indus- try into account, Netflix disrupted their industry norm through savvy distribution. The company declared it was going to send consumers movies via the Internet—even when they recognized that the Internet was not fast enough to handle it. Netflix started by mailing DVDs (a strategy that ultimately bank- rupted their competition, Block- buster) because they could exe- cute that strategy, while waiting for Internet speeds to reach a point that the company could deliver content via the web. Value-based care means sharing risk. Fully understanding all risk factors and how everyone interre- lates is vital to developing a pro- gram that make the most of the opportunity for the surgeons and ASCs involved. Another key decision is deter- mining the best entity to manage a bundled payment program: will it be a practice, an independent prac- tice association (IPA) or managed service organization (MSO), the ASC, or another entity? Each pro- gram could have a different answer, but these are the questions that must be addressed.
Negotiating a Bundle Prior to contacting a payer, it is impor- tant to answer critical questions like who is involved, who is controlling the bundle, how will patient progress be tracked and what are the expected savings. The payer will not do the upfront homework. The partnership needs to clearly articulate the total value proposition to get the chance to move forward and remain in the driver’s seat. Once negotiations begin, the partnership will be challenged
Prior to contacting a payer, it is important to answer critical questions like who is involved, who is controlling the bundle, how will patient progress be tracked and what are the expected savings.”
—Chris Bishop, Regent Surgical Health
on several material terms that go beyond price and that will dramati- cally impact the success of the pro- gram, including: ■■
Patient copay/deductible responsi- bility and notification requirements ■■ Timing of payments ■■
■■ ■■
Acceptance of risk—stop-loss pro- visions, how much can be assumed and managed
What will be included/excluded in the bundle
If accepting risk, what risk will the partnership assume—any readmis- sion? Only related to the surgery— if so, how will it be determined?
■■
Will there be quality metric require- ments—if so, what are they and
how/when will it be determined if they are met?
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What contracting/notification require- ments are needed with down- stream providers?
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How to protect and reconcile any potential double billing that occurs?
Identifying Key Stakeholders Getting involved in a bundle will change the way doctors practice medicine. The new method incor- porates risk and involves work- ing with other providers. Today, most surgeons are paid to operate. Those willing to collaborate with other providers and accept respon- sibility for the patient’s episode of
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