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B
undled payment models work wonders for
facilities that perform predictable, repeat-
able surgeries such as total joint replace-
ments. In an industry where payment terms are
often so complex even the most skilled finance staff
have trouble understanding how (and why) the
payer came up with its reimbursement rate, a bun-
dled payment arrangement is refreshingly straight-
forward: You negotiate a single fee with an insurer
that encompasses every aspect of patient care from
the moment the case is scheduled until a pre-deter-
mined post-op date (most commonly 90 days). For
instance, we negotiated a single fee with insurers
that encompasses every aspect of care from sur-
gery, to rehabilitation and everything in-between, up
to 90 days post-op. The cost is published on our
website. A total knee replacement through our
EXCEL program is $24,250.
Bundled payment models let you manage the
entire episode of care and also offer the ability to, in
a large part, dictate costs. That means you can share
any financial savings that occur when you deliver a
quality outcome for less than the agreed upon fee
with surgeons and other providers. Of course, it also
means your facility is on the hook whenever costs of
care exceed the amount in the bundle.
With so much riding on the delivery of repeat-
able outcomes and the mitigation of unexpected
complications, you need to lean heavily on the
expertise of surgeons when developing the terms
of bundled payments. After all, there is no other
person on the surgical or administrative team who
The Secret to Bundled Payment Success
Lean on surgeon expertise to negotiate the best terms with insurers.
Business Advisor
Scott D. Anseth, MD
EXPERT OPINION In many situations, surgeons can spot cost-saving opportunities other staff cannot.
