Bundled payment programs may provide hospitals, physicians with financial opportunities
Patient optimization helps reduce complication risks, keep costs for bundled payment programs in check.
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According to a presenter, bundled payment programs may provide financial opportunities for physicians and hospitals, but certain factors should be taken into consideration to achieve the best results with these programs.
One way to reduce costs with bundled payment programs is to identify those hospitals within the bundled payment network that have the best outcomes, the best processes and the best clinical care, Sam D. Moen, BA, co-founder and chief operating officer of MDDirect, said at a meeting.
Bundled payment programs are a great way for employed physicians in hospitals or private practices to market themselves, he said.
“This is a great way to differentiate your hospital or private group to an insurer or employer, and that is to provide high quality care [and] low cost so you have good outcomes,” Moen said.
Understanding bundled payment programs
When a hospital or health care system implements a bundled payment program, hospital administrators need to understand which complications are covered by the program, be sure to have case managers or the proper clinical team enlisted to support the bundle, set up ancillary negotiations, and select the correct partnering providers and negotiate with them on specific bundled care instances, Moen said.
“What is important is to make sure you have buy-in from all of your partners that are participating in a bundle,” Moen said. “When you sign a bundle contract, it is the whole entity and not just the single individual physician. So, make sure everybody in your practice that is participating follows these procedures and avoids these poor outcomes.”
Furthermore, patients should be optimized prior to surgery to reduce the risk of complications and the need for reoperations, he said noting published results showed effective management of patients preoperatively reduced the risk of surgical complications from greater than 8% to less than 1%.
The “price” of a non-optimized patient within the bundle is steep, according to Moen. “It can result in a case that is over $200,000.”
Strategies for patient optimization
One strategy for preoperative patient optimization is identifying patients with anxiety and depression, which Moen said are the most common reasons for ER visits after surgery.
Preoperative optimization of patients with anxiety or depression can be improved through the collection of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder 7-Item Scale, he said.
“Case managers can institute this survey prior to surgery, so that you know this patient has these issues, you can put a plan in place and either delay the surgery or make sure that they have the proper resources,” Moen said.
In addition, surgeons can have patients sign a contract prior to surgery. This helps ensure patients follow and adhere to instituted protocols, such as losing weight before surgery, managing and correcting cardiac and diabetic issues or participating in mental health treatment if patients have anxiety and depression, he said.
It is also important for surgeons to collect the appropriate data so that they understand what the complication rate is after surgery, as well as the root cause of any complications, according to Moen. “[It is important to have] that information so that discussion with your partners, your administrators, the groups that you are doing the bundled payment with, the insurers, ... all goes a lot smoother,” he said.
For more information:
Sam D. Moen, BA, can be reached at 428 Minnesota St., Suite 500, St. Paul, MN 55101; email: samuel.moen@netclinic.com
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Moen SD. The case for outpatient total joint arthroplasty. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.
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