Bundled payments are ideally suited for such big-ticket procedures
as joint replacements, where the great deal of post-op care presents a
significant opportunity for cost-effective rehab. Bundles for joint
replacements vary significantly by geographic region, but typically
range from $25,000 to $35,000, says Alexe Page, MD, an orthopedic
surgeon and health services consultant based in La Jolla, Calif.
Consider that an infected joint can cost $150,000 to treat and you see
why insurers are interested in offloading the surgical risk to willing
facilities, which are then responsible for ensuring the surgery and
recovery go as planned.
"It's the facilities that must pay for readmissions, repair operations
and new implants if infections occur within the 90-day global period,"
says Dr. Page. "Treating an infection for $150,000 wipes out every bit
of profit, and then some, from an episode of care gone wrong."
What facilities need to do is demonstrate how they can provide the
same quality of care at a lower cost, and show insurers that they're
J A N U A R Y 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 6 3
Here's What a Total Knee Bundled Payment Looks Like
An orthopedic
surgical center
negotiated a
knee arthro-
plasty bundle
for $24,105.
The bundle is
comprised of a
flat price for 11
elements, from the pre-op visit to recovery. If the facility spends
$12,254 on the entire episode of care, as in this hypothetical exam-
ple, it would net $11,851 for each arthroplasty. — Daniel Cook
Bundle element Negotiated fee Actual cost Profit
Pre-op
visit
$100 $40 $60
Surgeon fee $4,000 $775 $3,225
Facility fee $5,000 $2,030 $2,970
Implant allowance $5,000 $5,000 $0
Anesthesia $1,800 $1,000 $800
Post-op office visits $235 $170 $65
Durable medical equipment $750 $344 $406
Physical therapy $500 $200 $300
Transportation to recovery suite $100 $75 $25
Recovery nursing $1,620 $1,620 $0
Recovery suite (hotel lease) $5,000 $1,000 $4,000
Totals $24,105 $12,254 $11,851