FEATURE
“Patient satisfaction was high; 98 per- cent said they would recommend a bun- dled payment methodology to friends. Complication rates were low, with a combined rate of subsequent emergency room (ER) visits, infections and read- missions of 0.67 percent in 2015. And financial savings were significant with an average of $7,648 per case.” The total cost is 30–60 percent less per bundled case than if the procedure had been per- formed in the hospital setting, he says.
Bundle Up
Will the bundled payment model work for ASCs? COMPILED BY SAHELY MUKERJI
T
he federal government has initi- ated broad adoption of bundled
payment methodologies in inpatient settings including the Bundled Pay- ment for Care Improvement (BPCI) initiative and, more recently, the Com- prehensive Care for Joint Replacement (CJR) regulations. According to the Centers for Medicare & Medicaid Ser- vices (CMS) more than 500 hospitals now participate in these programs. “Bundled care, however, has not been widely adopted in the ambula- tory environment with commercially insured or federally insured patients,” says Thomas D. Wilson, past president of the Federated Ambulatory Surgery Association (predecessor to ASCA) Board, co-founder and principal of Global One Ventures (G1), a third party administrator in Carlsbad, California, and chief executive officer of Monterey Peninsula Surgery Centers in Monterey,
California. “From 2010 to 2015, more than 2,000 commercially insured bun- dled surgical cases were performed in California ASCs with overnight stay capability
administered by Global
One Ventures.” The types of surgery involved included total and partial joint replacement and repair, major spine surgery, hysterectomy, thyroidectomy, mastectomy and breast reconstruction. The payers included Blue Shield of Cal- ifornia, UnitedHealthcare (UHC), and large self-insured employers and union groups, he says. The bundle included all facility and professional fees during the episode of care. The California Department of Managed Care (DMHC) approved the bundled payment agreements, and the California Department of Insurance (DOI) performed a regulatory review. “Results from the implementation exceeded expectations,” Wilson says.
12 ASC FOCUS NOVEMBER/DECEMBER 2016
Patient Education The bundle program paired a compre- hensive patient-centric education ses- sion with clinical advancements in anesthesia and surgery, says Scott H. Leggett, co-founder and principal of G1 and chief executive officer of Sur- gery One in Carlsbad. “The patient and a family member or friend received preoperative and postoperative educa- tion, including a surgery-specific guide that reviews the procedure and explains what could be expected with the sur- gery,” he says. “Pain management, recovery in the facility and at home— including appropriate and safe physi- cal therapy exercises—and frequently asked questions were also reviewed.” If possible, a home health agency made a preoperative home visit or call. The clinical staff discussed post-discharge care and instructions, including physi- cal therapy and home preparation, with each patient. “The visit allays patient concerns and anxiety while establish- ing expectations regarding pain con- trol, healing and resumption of normal activities,” he adds.
Financial Results
An essential component for a success- ful bundled payment program is the generation of savings, says Hilary W. Galbraith, vice president of operations at Monterey Peninsula Surgery Cen- ters. “The model is exceeding finan- cial expectations, especially in mature markets,” she says. “In Monterey County, where the network of provid-
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