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The risks of bundled payment adoption: Reflexion Health CEO Dr. Joe Smith weighs in

Bundled payment adoption can help make ASC procedures more efficient without sacrificing quality, according to Joe Smith, MD, PhD, and CEO of Reflexion Health, a medtech company that sells its VERA physical therapy device to ASCs in bundles.

Here, Dr. Smith weighs in on bundled payment opportunities.

Note: Responses have been lightly edited for style and clarity.

Question: Which procedures and specialties as a whole are best suited for bundled payments? What other top opportunities do you see in bundled payments for ASCs?

Dr. Joe Smith: Bundled payments present an opportunity for [orthopedic surgeons] to take back their practice. They get to determine the [treatment] their patients are going to get. They get to pick and choose what technologies they want to apply. [Orthopedic surgeons] enjoy getting the opportunity to redesign the care plan so that it's efficient, which is something both physicians and patients benefit from. In a bundled payment environment, if the surgeon is the one taking the bundle, they no longer have to think about billing for specific services. [Bundled payments] give more control and visibility for the [services provided] to their patients.

[Bundled payments] fit in well with the ASC movement because there you find a group of entrepreneurial surgeons who have decided that they understand the patient flow and are accountable for the patient outcomes, leading them to design the pre-surgery and recovery process.

Q: Who do you recommend ASCs consult when developing bundled payments?

JS: The rulebook around who you can pay and how much can be complicated. It takes a thoughtful analysis, which is, I think, why we've had conveners spring up that can help manage the flow of funds and bring the care pathways that provide greater efficiency. There's a middle industry that's been created for managing bundled payments. They offer protection for clinicians providing care and jumpstart efficiencies that bundled payments are meant to provide.

It remains to be seen whether the conveners will be a long-term participant, or if they're going to help drive early adoption. The tips and tricks about how to run bundled payments will be disseminated among the groups themselves. What's absolutely clear is that the clinicians who take control and redesign their care pathways are going to win in the long term, and so are the patients, when the system is being redesigned in terms of overall efficiency.

Q: What are the risks involved when developing bundled payments? How can ASCs avoid these?

JS: If you participate in these bundled payment programs, you participate in the financial upside, but you also participate in the financial downside. What some of these intermediate organizations do is underwrite the clinicians on the downside risk, or some clinical groups have gotten outside insurance to help prevent big losses that can occur. The greatest protection from that risk is being efficient and running a high quality organization. There's plenty of data that shows that quality and costs can go together.

More articles on coding, billing and collections:
Third-party vendor hack exposes nearly 12M Quest Diagnostics records — 5 takeaways
3 things to know about out-of-network payments' effect on ASC value
The changing bundled payment landscape for ASCs — What to know about risk, payers & future trends

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