Although it will not be a participant anytime soon in any CMS bundling program (the state of Maryland is under a Medicare waiver), Johns Hopkins is betting that more bundling is on the way, and not just in the academic medical center.
"We are working on bariatric surgery and spine, and looking at certain surgical oncology procedures," Frick-Hoff says. "It's definitely a growth area. We're a pretty well-oiled machine now and generating almost $46 million in revenue this year on approximately 400 procedures."
A major difference in Johns Hopkins' commercial bundles versus the new CMS ones is that they do not include postacute care. Instead, the focus is on eliminating waste in the operating room as well as avoiding the need for skilled nursing altogether. The success of the bundling program lies more in selecting the right patient and providing the right care, she says.
By product line, joint replacement is 23% bundled, bone marrow at 50%, and solid organs are in the 20%-25% range. But cardio is at less than 5%.
"I think we still have a fair way to go," says Frick-Hoff. "We haven't launched this in any of our community hospitals, so there's still a lot of room for growth and for us to be more innovative. Not everything can be bundled, but it's one piece of the puzzle to help meet the triple aim."
Reeve, from San Antonio, also expresses a strong desire to participate in commercial bundles.
"We think we could help people and employers with better outcomes at a better cost," he says. "The commercial side will eventually head that way. There are numerous things that need to happen, but eventually it will and we'll be well positioned. From our side, we're ready to do it today."
Philip Betbeze is senior leadership editor with HealthLeaders Media. He can be reached at firstname.lastname@example.org.
Philip Betbeze is the senior leadership editor at HealthLeaders.