Hospitals are usually the episode initiators for bundling, but a physician group in Durham, North Carolina, has developed a commercial bundle of orthopedic services.
This article first appeared in the December 2015 issue of HealthLeaders magazine.
Bundling of orthopedic services requires optimizing the patient experience and finding postacute care partners who will follow the protocols that make the difference between winning and losing, say healthcare leaders experienced with this increasingly common reimbursement.
Hospitals are usually the episode initiators for bundling, but a physician group in Durham, North Carolina, has developed a commercial bundle of orthopedic services. Triangle Orthopaedic Associates began discussing the idea of bundling with Blue Cross Blue Shield of North Carolina in 2011, but it took almost two years to work out the plan, says Chief Administrative Officer Chris Adkins.
The orthopedic group has 63 physicians in 23 locations covering 12 counties, including eight urgent care clinics, seven MRI locations, and numerous physical therapy facilities. Triangle began bundled payments for total knee replacement with BCBSNC in December 2012. Since then, it has added a total hip replacement and a unicompartmental knee bundle.
The bundles are prospective payment models, so Triangle has negotiated a flat rate with BCBSNC for each procedure, including any services needed for 90 days post-op. Triangle is paid the full amount and is responsible for its contracts with the hospital, anesthesia, durable medical equipment, and therapy. "We share in the risk for that patient's outcome," Adkins says.
Success key No. 1: Optimize the patient experience
Bundling puts the pressure on providers to produce a good patient outcome, and that can be difficult if patients avoid services like post-op therapy because of the cost or hassle, Adkins notes. That is why Triangle's bundling arrangement with BCBSNC improves the patient experience wherever possible.