AS I SEE IT


care are in an excellent position to thrive in this changing environ- ment. Not every provider or facil- ity will be able to adapt to this way of thinking and it is incredi- bly important to know how to iden- tify the right partners for the value- based-care environment and to fully understand their motivations for being involved.


Choosing the right bundle part- ners means understanding the needs and concerns of each partner: ■■


Surgeon—They often are in the best position to direct the patient and choose the optimal care path- way. Since surgeons are cur- rently incentivized to stay in the operating room, it will be impor- tant to determine how to influ- ence them to educate patients about care options including facilities where they can receive high-quality care at the lowest possible cost.


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ASC—Requires leadership and partners to approach things dif- ferently. Fair compensation will encourage participation and gar- ner support for investing in new equipment and necessary staff training that will allow some higher acuity procedures to move outpatient.


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Hospital—Many of the ideal cases for bundle payments have histori- cally buoyed hospital profitabil- ity or, in some instances, financed unprofitable services. It is critical to recognize the economics of a hospital and understand if a bun- dle would free up hospital space for even higher acuity patients, or if shifting care to lower cost sites would align with the hospital’s value-based contracts.


■■


Anesthesia—Anesthesia protocols are not all the same. It is impor- tant to determine if existing anes- thesia partners use techniques


lead and broker the relationships between all parties. There is no one- size-fits-all approach to structuring and managing these relationships. Determine who will take the lead and manage the contracting, claims processing, accounting, accounts payable and data collection pro- cess. Decide who will oversee the relationship management that is necessary to ensure ongoing trust amongst all the players. Clarify if a board is necessary.


When identifying the right person


that allow patients to move out- patient. Specifically, will anesthe- siologists get patients ambulatory quickly, participate in pre-patient screening and develop post-oper- ative pain protocols that allow the patient to go home as soon as possible.


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PT and home health—Post-oper- ative care is critical. Evaluate pre- ferred physical therapy vendors and determine if incentives can be created that will ensure effi- cient, convenient and cost-effec- tive treatment.


Implant vendors—Implants are typically one of the largest indi- vidual costs in a bundle. It is important to structure a program that incentivizes surgeons to opti- mize the value of implants and determine if there is an opportu- nity to standardize or develop a capitated payment model. If sur- geons work closely with suppli- ers, implants can be a great area of value. Given the responsibilities at stake, it is critical to have someone


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or organization to lead this process, consider the following criteria: 1. Must have skin in the game. 2. Must be able to balance the over- all need of the bundle partner- ship with the individual needs of each partner.


3. Must have the ability to mobilize the partnership to move quickly, adapt and thrive.


4. Must be creative in finding ways to align the interests of the parties.


5. Must have time to accomplish this laborious process and under- stand the commitment required to seeing it come to fruition. The industry does not have


a


bundled payment playbook to guide the way. While execution is dif- ficult, it is unquestionably within reach for progressive surgeons and ASCs that are willing to shift their focus from day of surgery toward a comprehensive episode of care and for those who are willing to under- stand the needs of each partner, how to control risk and how to success- fully manage.


Chris Bishop is the chief executive officer of Regent Surgical Health in Westchester, Illinois. Write him at cbishop @regentsurgicalhealth.com.


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