Issue link: https://beckershealthcare.uberflip.com/i/1094308
48 ORTHOPEDICS Outpatient total joint 90-day bundled payment program hits 300+ cases: 4 Qs with Dr. Steven Lucey By Laura Dyrda S urgical Center of Greensboro (N.C.), a Surgical Care Affiliates facility, is a pioneer for outpatient total joint replacements and physician-driven bundled payments at ASCs. Last year, surgeons at the center performed 250 total joint proce- dures, and since launching its outpatient commercial 90-day pro- spective bundled payments in 2017, the group has completed more than 300 procedures. e group first contracted with Blue Cross Blue Shield of North Carolina and later inked deals with Aetna and Cigna, as well as a regional payer. e physicians launched a consulting business, Valere Bundled Solutions, to focus on building the relationships with executives in charge of value-based initiatives. Here, Steve Lucey, MD, discusses how his group developed bundled payments, lessons learned and where he sees these relationships headed in the future. Question: What was the process for developing the 90-day prospective bundled payments? Why did you decide to go that route? Dr. Steve Lucey: e Bundled Payments for Care Initiative experi- ence taught us that controlling the entire 90-day episode is impor- tant to control both the anchor episode and the post-acute spend. We also learned that a prospective bundle gave us far more control over the spend from a business standpoint and focused us on stan- dardizing practices. Q: What challenges have you come across now with around 300 cases completed? Did anything surprise you? SL: ere were two key challenges. First, getting the payers to the table with good historic spend information to negotiate. ey haven't had good soware solutions to do that. And second, we needed an informatics platform to do case management as well as run the financials of the bundle, which includes paying downstream providers and quarterly reconciliation with the payer. We ended up designing a soware platform uniquely to do this, called ValereC- ARE. e only surprise was that payers weren't more flexible and nimble to change to this value-based paradigm. Q: How do you see bundled payments and payer rela- tionships evolving with ASCs in the future? SL: It is going to grow fast once the payers and providers figure out how to get to the table and gain alignment. We have formed a consulting company to help that very thing happen, Valere Bundled Solutions. In fact, we are hosting a Summit on Outpatient Bundles where we will bring joint surgeons and payers together to facilitate these arrangements in other markets so they can experience the same success we have had locally. Q: What do surgeons need to know as they prepare for bundled payments? How can they set themselves up for success? SL: ey need to lead the discussion and take ownership of the bun- dle business. ey need to realize the clinical decisions they make are, by default, also financial decisions. ere are other complexities, such as insuring the bundle, standardizing pathways and risk assess- ment that they will need to learn as well. n Laser Spine Institute shuts its doors, patients from 4 ASCs diverted: 5 things to know By Laura Dyrda T ampa, Fla.-based Laser Spine Institute was unable to secure financing to continue operations and closed March 1. Five things to know: 1. Over the past six months, the company closed three surgical centers and reduced its operating cost structure, but it was unable to develop a sustainable cost structure. As a result, Laser Spine Institute ceased operations and is transferring patients to local competitors. 2. The centers that remained open until last week included facilities in Tampa, Cincinnati, Scottsdale, Ariz., and St. Louis. Laser Spine Institute has reached out to other surgical providers in those communities to potentially send patients who were scheduled for procedures at the closed centers. The company also reached out to patients slated to have surgery after the centers closed and referred them to other in-market options. 3. The company reported it was unable to "attract the necessary financing to undertake a Chapter 11 process and continue operations." In 2016, it opened a new $56 million headquarters in Tampa. 4. Laser Spine Institute employs around 1,000 people at its four locations, including more than 500 in Tampa, according to ABC Action News. 5. Originally launched as a single operating room facility in Tampa in 2005, the organization has provided around 100,000 surgical procedures for patients with back pain and neck pain. n