Becker's ASC Review

46 CODING & BILLING Physician Driven Bundles — How 3 Physicians Took Control of the Bundle By Eric Oliver F our joint replacement surgeons from three separate private orthopedic prac- tices in Greensboro, N.C., are handling bundled payments in a different way; by managing it all themselves. Steve Lucey, MD, a sports medicine and joint replacement surgeon in Greensboro, N.C., and his colleagues began the process of building one of the country's first physician- centered, value-based outpatient commercial total joint bundled program over 18 months ago. Aer learning about bundles by partici- pating in the Bundled Payments for Care Improvement program, they realized joint replacement bundles would work well in the commercial outpatient setting. e physicians formed a management company, Delta Joint Management, and learned how to become their own convener. In this model, they would make all clinical and financial decisions within the bundle. ey take on all the responsibilities, so they can be in total control of the entire episode of care for their patients. "We're making all the decisions, taking all the risk and managing the payments to best serve the patient needs," says Dr. Lucey. ey have completed almost 100 joint replacements in the first year with a 100 percent patient satisfaction rate, a zero percent readmission rate and a zero percent complication rate. Serving as the convener has also made a significant impact on their bottom line. In a traditional fee-for-service model, a physician would receive only 6 percent of the total 90 day spend for a total joint replacement procedure, despite having the most impact on costs, outcome and patient satisfaction. Under this model, the physician takes all the risk and thus keeps all the reward. In addi- tion, the entire process is simpler and more affordable for the patient, he says. Once the patient has paid their deductible on the front end, there are no further co-pays or bills during the entire episode of care. e goal for these Delta joint surgeons was to design a process where the patient's care was the focal point, thus improving the outcomes while also decreasing cost. e definition of value is outcomes divided by cost. is model creates tremendous value because it not only increases the numerator [outcomes] but also decreases the denomina- tor [cost]. By acting as convener, the physi- cians cut out the middleman and negotiates downstream contracts for all aspects of the bundle [facility fee, surgeons, anesthesia, implants, among others]. "We said, 'If we're in charge, then we'll make the best decisions for our patients. It was really about trying to do the right things for our patients," Dr. Lucey says. To assist other physicians in implementing their own bundles, Dr. Lucey and his col- leagues formed Valere Bundled Solutions. Valere Bundled Solutions is a consulting and technology company offering custom- ers the roadmap and informatics platform that will empower physicians to become their own convener in the outpatient com- mercial bundled payment setting. Valere offers a proven solution that simplifies and streamlines the successful alignment of all stakeholders throughout the entire con- tinuum of care while providing guidance, best practices and standardization, acceler- ating the growth of outpatient commercial bundles. n MedPAC Votes to Kill MIPS, Recommends Alternative Program By Ayla Ellison T he Medicare Payment Advisory Commission, a federal group tasked with advising Congress on Medicare, voted 14-2 Jan. 11 in favor of recommending Congress eliminate the Merit-based Incentive Pay- ment System. In a presentation at the meeting Thursday, MedPAC policy analysts criticized the program, saying it is "burdensome and complex" and "replicates flaws of prior value-based purchasing programs." "MIPS will not succeed in helping beneficiaries choose clinicians, helping clinicians change practice patterns to improve value or helping the Medicare program to reward clinicians on value," the presentation read. MedPAC commissioners in support of axing MIPS cite the financial burden on physicians to comply with reporting requirements and issues with the metrics. On Thursday, the commissioners recommended replacing MIPS with a new model, the voluntary value program. The VVP would include an across-the-board withhold for all fee schedule payments, and perfor- mance would be assessed using uniform measures across three catego- ries: clinical quality, patient experience and value. Commissioners in favor of the new program said it would better prepare physicians to participate in the Medicare and CHIP Reauthorization Act's other track, Advanced Alternative Payment Models. n

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