Outpatient Surgery Magazine

Year of the Nurse - November 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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2 0 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 2 0 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.

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