Becker's ASC Review

49 ORTHOPEDICS No regrets about dropping bundled payments, Rothman Orthopaedics president says By Carly Behm A lthough Philadelphia-based Roth- man Orthopaedics has eliminated bundled payments, its president, Alexander Vaccaro, MD, PhD, said using them is still worth it for some practices. He reflected on that decision a year later and told Becker's Spine Review how he thinks other practices should look at the payments. Question: At a Becker's event last year, you announced that Rothman was dropping out of bundled pay- ments. Has your view of bundled payments changed over the past year? Dr. Alexander Vaccaro: My view of bundled payments has not changed. It is an effective way of developing patient-fac- ing value-based healthcare decisions. The innate problem, however, is the intrinsic "race to the bottom" effect of bundled payments that reduces long-term reim- bursements to important stakeholders in the process. This, unfortunately, misaligns incentives to participate. I have not seen any material changes in the approach from CMS that would make continued participation in the [Bundled Payments for Care Improvement] program compel- ling. At Rothman, we are proud to deliver the highest-quality care, and affordabil- ity is part of our mission statement. We believe a commitment to increased value in healthcare should be rewarded for the long term, not just in the short term for initial savings. Q: What would you advise other practices to consider when it comes to bundled payments? AV: Every practice circumstance is unique. I think it is extremely important to engage in the process of bundled payments to un- derstand where a particular group is in their value proposition to patient-facing care. e ability to manage risk in reimburse- ment requires sophisticated data analytics, alignment among all stakeholders and the operational resources to navigate patients through evidence-based care pathways. Q: What other value-based models do you see developing in orthope- dics? AV: As practices become more sophisti- cated in their ability to manage risk, there will be a natural shift toward capturing premium dollars in the form of sub-cap- itation agreements. These arrangements may be with health systems, accountable care organizations, large primary care groups or any entity that is involved with Medicare direct contracting. Consider- ations for carve-outs, such as for spine procedures where there is greater vari- ability, would need to be factored in to ensure financial viability and maintain high-quality patient outcomes. Q: How will the payer market in Florida influence Rothman's opera- tions? AV: We will focus on delivering evidence- based, cost-effective care to local com- munities in the Florida market which is easily accessible so that we can exceed the expectations of our patients. n Laser Spine Institute founder sues former attorneys, says they caused $400M in losses By Laura Dyrda T ampa, Fla.-based Laser Spine Institute founder James St. Louis, DO, claimed in a lawsuit his former lawyers caused him to lose more than $400 million in a judgment by not communicating with him and breach- ing their fiduciary responsibilities. Dr. St. Louis filed the suit May 24 in a Florida circuit court against law firm Hol- land & Knight and the attorneys assigned to defend him against a lawsuit filed by his former business partner Joe Samuel Bailey. Mr. Bailey sued Dr. St. Louis in 2006 after he left the company they formed together, Laserscopic Spine Centers of America, and launched Laser Spine Institute. Dr. St. Louis worked with private equity firm EFO and Michael Perry, MD, another former partner at Laserscopic Spine Centers of America, to launch Laser Spine Institute, which grew into a multimillion dollar company. Laserscopic Spine Centers of America shut down in 2006. Holland & Knight was hired to represent Dr. St. Louis, Laser Spine Institute and other defendants in the lawsuit Mr. Bailey filed. The firm worked on the case for 10 years, but Dr. St. Louis claims his lawyers never spoke directly with him about the case and only communicated with Laser Spine Institute. Dr. St. Louis said the firm never informed him that Mr. Bailey sued him personally for hundreds of millions of dollars, according to the lawsuit. In 2019, the court decided in favor of Mr. Bailey, and Dr. St. Louis was ordered to pay $271 million. After adding pre- and post-judgment interest, the pay- ment has grown to more than $400 million. In his lawsuit, Dr. St. Louis also accused Holland & Knight of failing to limit his financial exposure and failing to end the litigation in a timely manner. He said the firm didn't inform him of settlement opportunities or the ability to buy Mr. Bailey's legal claims when Mr. Bailey filed for bankruptcy, which would have allowed Dr. St. Louis to dismiss the lawsuit. Dr. St. Louis claimed Holland & Knight's actions caused him "financial ruin" and has demanded a trial by jury. n

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