The key thing for ASC directors to know about bundled payments is that these are developed to reduce healthcare costs, improve outcome accountability, and create situations in which payers and providers share risk, savings, and costs.
Bundled payment models often include shared risk involving readmissions, ED visits, post-surgical care, and day-of-surgery care, including facility costs, surgeons, anesthesia, pathology, and lab work.
Commercial bundled payment plans seek to move patient volume to providers with favorable contract terms. They also compel doctors and ASCs to think about costs and motivate patients to use certain providers. It’s often referred to as value-based care, says Marian Lowe, MBA, senior vice president of strategy for USPI in Addison, TX. Lowe speaks at national conferences about bundled payment models.
“You can see bundled payments going in two different directions: retrospective and prospective,” she says. “Retrospective is paying fee-for-service claims, and someone is held accountable for the overall spend in a true-up on the back end of the time period. Prospective bundles are when the entity is given a fixed amount of dollars on the front end and is responsible for everything that happens to that patient.”
ASCs considering bundled payment models might consider how many patients the contracting organization can offer and which providers will participate. They also should determine the physician’s role in selecting and optimizing patients, managing care post-discharge, and collecting quality information. Transparency and accessible data, along with targets and benchmarks, also should be considered, Lowe says.
Surgeons and ASC directors might be skeptical about using a bundled payment model, but it is possible to find a bundled plan that will work for them and in their market, says Steven A. Gunderson, DO, chief executive officer and medical director of Rockford Ambulatory Surgery Center in Rockford, IL.
“At first, I felt bundled payments would never work in our community,” he says.
But Gunderson kept an open mind, and soon he learned more about the model and was interested.
“I talked with some people who were putting together companies to sell plans to self-insured employers, and one of them contacted me,” he says.
When The Zero Card contacted Gunderson, he agreed to put together a bundled payment price.
“I looked at our costs and put together a bundled payment plan that was very favorable to surgeons who participate in it. I pay them a higher percentage of the normal surgeon’s Medicare rates,” Gunderson explains. “I had no trouble getting multiple surgeons in our community to participate in this.”
The ASC has handled about 30 cases since beginning to schedule bundled payment patients six months ago. “It took a little while to gear up,” Gunderson adds.
Here’s how it works: A patient agrees to use the bundled payment plan instead of their employer’s regular insurance. The advantage to employers is that the bundled payment for ambulatory surgery is far less costly than the procedure typically would cost. Employees have an incentive to go with the bundled payment plan because they do not have to pay any deductibles or copays. The surgery is free to them, versus costing them hundreds of dollars out of pocket. From the ASC’s point of view, surgeons are happy to receive additional business, and their bundled payment amount covers everything it needs to cover.
“We distribute the reimbursement directly to the surgeon and anesthesia provider, and we keep the difference,” Gunderson says.