Becker's Spine Review

29 PRACTICE MANAGEMENT Q: How is Twin Cities navigating the ongoing challenges brought by the pandemic? AJ: Now, we're dealing with a second wave of COVID-19 cases and a second wave of hospitals postponing what they call elective orthopedic procedures. We're quickly pivot- ing to address staff shortages at hospitals and potential bed shortages due to the pandemic. Naturally, that means some of our cases will be postponed. Fortunately, our local depart- ment of health and state officials have not prohibited surgeries at ASCs at this time, nor are they limiting interactions in clinics. We're business per usual in our clinics, ASCs and our ancillary facilities as part of the practice. Currently, the only thing that's being impact- ed is our inpatient surgeries. Q: How did the practice cope with the first wave of COVID-19 cases ear- lier in the year? AJ: For about eight weeks, with the cessation of elective procedures at the onset of the pan- demic, we took about an 85 percent hit. We've been operating at our usual capacity since about mid-May when surgical restrictions were lied. For about eight or nine weeks, we were actually operating above our historical averages, simply because we were working through that backlog of cases. We were smooth sailing until about a week and a half ago when we saw COVID-19 cases rising in Minnesota and Western Wiscon- sin, where we also treat patients. We're starting to see numbers dip a little bit again now. Q: We've seen a significant number of mergers and acquisitions in the or- thopedic field this year. Do you think these larger groups are the future for orthopedics? AJ: I think consolidation in orthopedics has been accelerated by the pandemic. One of the benefits of being a larger group is the econ- omies of scale as well as the ability to nego- tiate better contracts with implant or supply vendors. Additionally, from a reimbursement standpoint, typically the larger groups are able to leverage the commercial payers and negotiate more lucrative contracts. As the pandemic hit and groups started to see this financial pressure and the financial crisis it created, it was quick for them to realize that long term — if they wanted to be a viable, autonomous independent practice — they re- ally need to band together to be able to deal with some of these pressures and challenges. Q: Turning to value-based care, how is Twin Cities' bundled payment pro- gram for total joints performing? AJ: We created our Excel program in 2011 and performed our first cases in 2012. is year, 2,200 of 10,000 total joint surgeries are expected to be done as part of our bundled payment program. It's a prospective bundle, so we have the same rate for all commercial payers. We don't negotiate up or down de- pending on the payer. A total knee from Blue Cross is going to be the same price for any other payer on the market. It includes every- thing from the date of surgery in one of our ASCs and extends for about 90 days postop- eratively. For that bundled payment, you're getting a surgery center facility fee, physician fee, a PA or nurse practitioner fee. Anesthesia fees are included, our patients are discharged from an ASC to an orthopedic recovery care suite. Initially we outsourced that with assist- ed living facilities but recently we've built out our own care suite in house. Typically, patients stay one night at the care suite, but they can stay longer. Most pa- tients go home on the day aer surgery. In the care suites, patients receive nursing care and in-room physical and occupational ther- apy. ey're also rounded on by an internal medicine or family medicine physician as well as our orthopedic surgeons before being discharged. From there, any follow-up care in clinic and any outpatient physical therapy services at our facilities are included as part of that bundled payment. e philosophy of the program is to provide the highest quality care and outcome we can, and provide that at a lower cost. at was really the impetus for this program. We want to give patients a bet- ter experience than they receive at a hospital at a lower cost, and reduce their out-of-pock- et expenses and costs of the healthcare sys- tem in general. On average, we're being paid about 30 percent less than what a traditional fee-for-service episode of care might be for that total joint or complex spine procedure. Q: Have you achieved similar success for bundled payments in spine? What spine cases are included? AJ: e Excel program includes total knees, hips, shoulders and ankles as well as one- and two-level ACDFs, one- and two-level lumbar fusions and cervical disc replacement. I think one of the benefits that our program provides is that recovery care suite. For spine, if you're looking at a typical true discharge-to-home same-day surgery type of program, you're going to run into concerns with anesthesia providers and surgeons about potential air- way issues and complications that may occur when patients get home in that first 24 hours. We can really keep an eye on patients and care for them in the suites during this time. I would call our program more of a hybrid model be- cause it's not true outpatient same day, but it's also not in a hospital. e care suites feel more like really nice hotel rooms. I think that struc- ture allows us to accommodate those spine patients and manage any potential issues or postop complications that may arise. n Merger of 2 spine practices creates 20-physician entity By Angie Stewart Two South Dakota spine practices merged to form The Spine Center at Black Hills Orthopedics, according to a December announcement. Black Hills Orthopedic & Spine Center and Black Hills Neurosurgery & Spine merged on Sept. 1. Both are based in Rapid City, S.D. The combined entity comprises 20 physicians, including five spine surgeons and a neurologist, who perform most of their surgeries at Black Hills Surgical Hospital in Rapid City. The Spine Center will enable the previously separate practices to "deliver the most advanced, comprehensive head-to-toe orthopedic, back, neck and nerve-related care in Northern Wyoming, Western South Dakota, Western North Dakota and Northwestern Nebraska," said Kyle Wiese, CEO of Black Hills Orthopedic & Spine Center. The merger also combined ProMotion Physical Therapy with Black Hills Ortho- pedic and Spine Physical Therapy, both in Rapid City. The merger comes not long after Gillette-based Black Hills Orthopedic & Spine Center of Wyoming's acquisition and opening of an outpatient surgery center in Gillette: Black Hills Surgery Center of Wyoming. n

• Cover