At the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 14, Marshall Steele, MD, an orthopedic surgeon and medical director of Stryker Performance Solutions and founder and CEO of Marshall Steele & Associates, discussed bundled contracting initiatives for orthopedic and spine.
He began by discussing some of the concerns with cost and the fragmented healthcare system, as well as public dissatisfaction with healthcare. He discussed several shifts in how providers are paid, including a move from independent physicians to interdependent ones who rely on bundled payments.
In order for physicians to get on board with bundled payments and accountable care initiatives, "We need to create models where we control the entire continuum of care," Dr. Steele said. "We need to know exactly what are costs are so we can managed that effectively."
Physicians who are proactive about bundled payment contracts gain experience with accountable care and have an opportunity to strengthen relationships between hospitals and physicians and improve overall quality of care. Dr. Steele said the challenge for some physicians is that they are generally not the most savvy business people, and practices may be lacking in business analytics.
Dr. Steele also discussed ways orthopedic and spine surgeons can adapt to bundled payments and accountable care. He said physicians reimbursed through bundled payments need to be customer-focused, understand the value of care and reduce waste, as well as reduce variations.
He discussed CMS' Bundled Payment Program and its four models, three of which are retrospective and one that is prospective.
Additionally, Dr. Steele addressed four requirements for maintaining success in bundled payment and accountable care structures:
1. Creating a strong administrative and physician partnership. The key, according to Dr. Steele, is that everyone shares a vision and is on board with clear metrics for success.
2. Thinking differently as a physician. "Physicians can no longer be cowboys," Dr. Steele said. "You need physicians who have great experience with patients and who can quarterback your medical team."
3. Implementing a culture change. For accountable care and bundled payments to work, physicians will need to transition from thinking as an individual provider to being a part of a medical team, Dr. Steele said. This is best achieved through a cultural change. Providersalso may need to:
- Stop working around fixes;
- Move toward standardized testing and care;
- Start relying on checklists, not just memory;
- Continuously seek ways to improve the system;
- Shift from competence to expertise;
- Rely heavily on metrics;
- Move from secrecy to transparency; and
- Transition from prison vocabulary (i.e. the word 'discharge') to using different language.
4. Manage the whole continuum of care. In an accountable care model, patient care happens not just when a physician sees the patient, but also before and after an episode. Dr. Steele suggested determining how healthy patients are before and after a visit. He also noted that home care plays a crucial role in accountable care. He suggested training family members before caring for a patient, in order to be in better control of the continuum of care.
Dr. Steele concluded the session by saying physicians should never forget a tried-and-true method of marketing. He said to remember the "best marketing will always be word-of-mouth, and great word-of-mouth depends on patient experience."