Channel Sponsor - Coding/Billing/Collections

Sponsored by National Medical Billing Services | info@nationalASCbilling.com | (636) 273-6711

Should your ASC bundle? Dr. Randolph Bishop on navigating a spine program

Bundled payment programs are receiving a lot of buzz in the value-based arena, but developing a bundled product is no straightforward task.

Before surging ahead into a bundled payment program, ambulatory surgery centers should first decide whether its surgeons and facility can perform the desired service at a competitive market Bishopprice. Consider whether the ASC has the ability to operate the business with the margin generated by government payers.

Once an ASC understands its capabilities, it can build a bundled spine surgery product by calculating an accurate facility cost combined with the surgeon payment.

"The goal would be for the facility and surgeon to assume the risk of the episode of care and therefore should cover all aspects of the surgery with the exception of indirect complications," says Randolph Bishop, MD, MBA, a neurosurgeon at Neurological Institute of Savannah (Ga.).

Certain ASCs pose as superb candidates for bundled payment programs. Surgeon-owned centers and centers specializing in spine are especially groomed for bundled payments.

"Many ASCs that specialize in spinal procedures already have a very efficient cost structure, employee specialization and capital materials necessary to perform a bundled surgery service really in most surgical operating rooms," explains Dr. Bishop.

A bundled payment program presents a surgery center with a multitude of benefits, as it allows the "facility and payer to better predict cost associated with treatment of specific diagnoses." The combination of the surgeon and facility payments ultimately promotes efficiency across all areas of the ASC.

But the success of a bundled payment program depends greatly on patient selection. Successful programs will accept patients with a pathology that allows for an accurate and predictable cost estimation. Bundled payment patients are often healthier with less comorbidities. If a patient has various illnesses, centers run the risk of one illness progressing during an episode of care, which results in a stark hike in cost of care.

"Many times these potential large fluctuations in the cost of care are largely out of the surgeon's control," adds Dr. Bishop.

A bundled payment program may become tricky, however, if treating a patient with a complex hospital course that involves multiple providers and facilities.

Looking to the future, Dr. Bishop believes there is "real opportunity to use existing resources, skills and efficiency developed in the ASC environment in a hospital or accountable care organization looking to provide incremental spine surgery services." In a similar vein, the healthcare industry may stand to benefit from leveraging skills already in place in existing healthcare delivery organizations. This could "lead to a marked reduction in the cost of providing these services to patients in their clinically integrated networks," says Dr. Bishop.


To see Dr. Randolph Bishop and 120+ other speakers discussing the biggest trends and topics in ASCs and healthcare today at the Becker's ASC 23rd Annual Meeting - The Business & Operations of ASCs on Oct. 27-29, 2016. Click here to learn more and register!

More articles on coding, billing & collections:
Healthcare costs to hit $30k by 2020 for family of 4: 7 notes on healthcare spending
Report: Expanding Medicaid lowers insurance premiums: 5 takeaways
6 ways payers and providers can reduce claim denials

© Copyright ASC COMMUNICATIONS 2018. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Top 40 Articles from the Past 6 Months