every joint replace-
ment patient to inpa-
tient rehab, surgery
centers send appropri-
ate patients home,
where recovery is less
expensive," he says.
A physician-owned
orthopedic surgery center near Mr. Domyahn discharges patients to a
hotel across the street for observation following surgery. "The prac-
tice told local payers that their team, from the surgeons to the physi-
cal therapists, could care for patients cheaper and better," says Mr.
Domyahn. "The cost structure is lower, so the facility is making
money, and insurers are paying less than they would if patients had
gone to the large local hospital. It's a win-win, and patients are still
receiving high-quality care."
Be sure to negotiate exclusions into payment bundles to protect
yourself from medical complications unrelated to the surgical care
performed, says Dr. Page. For example, make sure hospitalizations for
the treatment of medical complications related to diabetes or heart
disease aren't included in the 90-day care bundle.
"The better prepared you are to give insurers a comprehensive pic-
ture about what you will and will not pay for, and the less you leave
up to negotiation, the better off you'll be," she says.
When getting started, work with a single physician champion and
focus on a single specialty to get a feel for how the system works,
says Mr. Leggett. He says now's the time to launch a program, because
"in 10 years, most elective procedures will be reimbursed through
bundled payments."
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Facilities have to know the
exact cost of surgery to make
bundled payments work, so
they can put a clear price on
the procedures they host.