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Competitive advantage, key strategies & adoption of bundled payments — 3 Qs with Dr. Stephen Ritter

Although risk aversion has kept some physicians from pursuing bundled payment models, the approach has never been more relevant in the ASC world, according to orthopedic spine surgeon Stephen Ritter, MD.

Dr. Ritter is a partner in Carmel, Ind.-based Methodist Sports Medicine and the founder of Olio Health, a collaboration technology company that supports health systems, physicians, and post-acute entities manage episodic risk.

Note: Responses have been lightly edited for style.

Question: How can bundled payment models help practices get ahead of their competitors?

Dr. Stephen Ritter: All risk-based reimbursement models, including bundled payments, were put in place to reduce costs, drive better patient experience and improve outcomes; ultimately, to improve healthcare value. From a clinical perspective, bundled payments formally deepen and often lengthen the patient-physician relationship. Surgeons and their teams must remain involved postoperatively through the entire episode of care, as defined by the specific bundle. Never has this been more relevant than in the current ASC environment, as more and more traditional inpatient procedures are being advanced to the ambulatory setting. Often, these procedures carry a higher level of complexity and require novel approaches to care post-ASC discharge.

Undoubtedly, more complex patients will require post-surgery care (social services, [outpatient] therapy, home health, skilled nursing facility [care] at times) — patients benefit and value improves dramatically when physician, acute and post-acute teams remain engaged and collaborate. Practices that invest in processes and technologies that extend beyond their controlled environment to deliver higher value gain an advantage over their competitors who are simply focused on efforts within their own walls.

Q: What are the keys to success when implementing a bundled payment program?

SR: I organize the keys to bundled payment success into three categories:

Data. Physicians are data-driven creatures and need consultative, digestible information on their costs and overall efficiency of their delivery of care; many times the data doesn't reflect who you think you are, nor your downstream partners. It is necessary to carefully analyze the data on your own practice and use those analytics in bundled payment decision-making.

Culture. Teamwide buy-in is essential to take on risk and commit to value-based care, which requires continuous learning and evolution. You can't go half-hearted[edly] into bundled arrangements and expect to deliver for your patients and have financial success.

Post-acute collaboration. Much of the patient care in a bundle is in the post-acute care environment that you don't have direct control over. Effectively collaborating with post-acute care providers is critical to success. Physicians need to know where their patients are post-ASC discharge, have visibility into their progress, and be able to collaborate with post-acute providers in real-time to drive outcomes. Investing in infrastructure to support your patient and ensuring a bundle isn't busted by unnecessary care or by the complexity of the patient's unique situation are critical considerations.

Q: Why do you think practices have been slow to adopt bundled payment models?

SR: It's mostly due to risk aversion on the economic unknown — not philosophical or clinical reasons that practices have been slow to adopt bundled payment models and/or risk. Prices for healthcare delivery remain opaque. Without people, processes and/or technology that supports them to assume risk, physicians will be reluctant to jump into these models. Physicians must see a path to success, or they likely will rely on traditional clinical and business practices to try to keep themselves solvent. This approach is rapidly becoming untenable.

To participate in future Becker's Q&As, contact Angie Stewart at For a deeper dive into ASC industry trends, attend the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC in Chicago, June 13-15, 2019. Click here to learn more and register.

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