How Surgical Care Affiliates' CMO gets physicians on board with bundles + 4 more insights

As chief medical officer for Deerfield, Ill.-based Surgical Care Affiliates, Daniel Murrey, MD, spearheads many initiatives related to bundled payments and value-based care.

Dr. Murrey shared his knowledge with Becker's ASC Review.

Note: Responses were lightly edited for style and clarity.

Question: How did you get independent physician practices to buy in to bundled payments before they were top-of-mind across the industry?

Dr. Daniel Murrey: We shared what we were hearing from patients — that hospital charges were out of control and they wanted to know what we were doing about it. And we offered surgeons the chance to be part of something innovative and new. Being a part of redesigning care delivery is attractive to surgeons.

Q: What are some best practices for negotiating bundled payment agreements in independent ASCs?

DM: It's important that the patient cohort is appropriate for an ASC. You have to limit responsibility to things you can actually control.

Q: What are you most skeptical about when pursuing bundled payment agreements?

DM: Most payers, including CMS, have started with retrospective shared savings programs. These don't pay out until many months after care is delivered. This makes surgeons skeptical that they will get paid, and even when they do, it's hard to tie it back to specific actions you took. If you can achieve meaningful volumes, then you can follow trends in performance in retrospective programs, but ideally prospective agreements motivate surgeons the best.

Q: When researching bundled payments and value-based care, what's the most eye-opening or interesting insight you've come across?

DM: The majority of dialogue about value-based care has centered on primary care, and most are familiar with the continuum of risk that primary care has taken — patient-centered medical homes to accountable care organizations and clinically integrated networks to capitation. Specialists have a similar continuum of progressive risk, starting with site-of-care quality incentive payments to case rates and bundled payments to sub-capitation. Rather than focusing purely on the primary-care physician role in value, the highest-performing systems will have robust collaboration between PCPs and specialists.

Q: Are there any misconceptions about bundled payments that need to be cleared up?

DM: The criticism of bundled payments has been that they don't affect utilization, only cost. In fact, that isn't the case, especially in prospective bundles. Surgeons who take prospective risk need to be very careful about patient selection, and as a result, are less likely to operate on those who might get marginal benefit from surgery. Taking risk-based payments makes you attuned to both reducing costs and eliminating low-value care.

Interested in participating in future Becker's Q&As? Email Angie Stewart at

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