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Physician driven bundles — How Drs. Steve Lucey, Frank Aluisio, Matt Olin and Frank Rowan took control of the bundle

Four joint replacement surgeons from three separate private orthopedic practices in Greensboro, N.C. are handling bundled payments in a different way, by managing it all themselves.

Dr. Lucey and his colleagues started the process of building one of the country’s first physician-centered, value-based outpatient commercial total joint bundled program over 18 months ago.

After learning about bundles by participating in the BPCI program, they realized joint replacement bundles would work well in the commercial outpatient setting. The physicians formed a management company, Delta Joint Management, and learned how to become their own convener. In this model, they would make all clinical and financial decisions within the bundle. They take all the responsibilities, so they can be in total control of the entire episode of care for their patients.

"We're making all the decisions, taking all the risk and managing the payments to best serve the patient needs," says Dr. Lucey.
They have completed almost 100 joint replacements in the first year with a 100 percent patient satisfaction rate, a zero percent readmission rate and a zero percent complication rate.

Serving as the convener has also made a significant impact on their bottom line.

In a traditional fee-for-service model, a physician would receive only 6 percent of the total 90 day spend in a total joint replacement procedure, despite having the most impact on costs, outcome and patient satisfaction.

Under this model, the physician takes all the risk and thus keeps all the reward. In addition, the entire process is simpler and more affordable for the patient, he says. Once the patient has paid their deductible on the front end, there is no further co-pays or bills during the entire episode of care.

The goal for these Delta joint surgeons was to design a process where the patient’s care was the focal point thus improving the outcomes while also decreasing cost. The definition of value is outcomes divided by cost. This model creates tremendous value because it not only increases the numerator [outcomes] but also decreases the denominator [cost]. By acting as convener, the physicians cut out the middleman and negotiate downstream contracts for all of the parts of the bundle [facility fee, surgeons, anesthesia, implants, among others].

"We said, 'If we're in charge, then we'll make the best decisions for our patients. It was really about trying to do the right things for our patients," Dr. Lucey says.

To assist other physicians in implementing their own bundles, Dr. Lucey and his colleagues formed Valere Bundled Solutions. Valere Bundled Solutions is a consulting and technology company offering our customers the roadmap and informatics platform that will empower physicians to become their own convener in the outpatient commercial bundled payment setting. Valere offers a proven solution that simplifies and streamlines the successful alignment of all stakeholders throughout the entire continuum of care while providing guidance, best practices and standardization accelerating the growth of outpatient commercial bundles.

Valere is hosting an Outpatient Commercial Bundled Payment Physician Summit on April 26 to April 27, 2018 at the Proximity Hotel in Greensboro to discuss their physician-centered bundle model. The summit is free for physicians interested in developing an outpatient total joint program. Participants will learn about the clinical and business aspects of convening commercial outpatient joint surgery bundles. They will tour the brand new state-of-the-art Surgical Center of Greensboro, a SCA affiliate, where these surgeries are being performed. For more information on the Valere Summit, click here.

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