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Did Skin Prep Fuel This Fire? - February 2017 - Subscribe to Outpatient Surgery Magazine

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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

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