ASCs, payers ramp up bundled payment initiatives as drive to value-based care continues

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Several payers are expanding bundled payment programs this year as studies continue to document the cost savings that payers, providers and patients can achieve through well-organized value-based initiatives.

Anthem Blue Cross and Blue Shield in Ohio and Sharonville, Ohio-based Beacon Orthopaedics & Sports Medicine are piloting a bundled payment agreement that saved employers more than $1 million in its first year.

Launched in July 2020, the spine and total joint replacement program provides more opportunities for surgeries to be done at Beacon's ASC instead of hospitals, and is "driving cost savings and quality," according to Beacon CEO Andy Blankemeyer.

These cost savings, as well as improved patient outcomes — because of increased coordination among providers — are pushing more payers to build out value-based programs.

In August, Regence BlueCross BlueShield of Oregon added Rebound Orthopedics & Neurosurgery, a 36-physician practice, to its Episodes of Care program, which offers bundles for various procedures such as lumbar spinal fusion, shoulder replacement, and hip and knee replacement and revision.

Seattle-based Regence BlueShield is also adding more providers and covering more procedures in its bundled payment program, which decreased the cost of orthopedic procedures by 16 percent since its January 2020 launch.

To capitalize on this trend, more ASCs are forging bundled payment partnerships as a way to better negotiate with payers and provide them with a competitive edge in the coming years.

"ASCs that have an ability to bundle their services for specific procedures, will have the opportunity to negotiate directly with self-insured employers, enabling their employees to get concierge type services at reduced rates," Christina Goodall, RN, DNP, administrator of Atlanta Orthopedic Institute, told Becker's. "By doing so, employers will reduce their loss time injuries and ensure that their employees receive high quality services in a controlled environment."

Surgical Center of Greensboro (Tenn.) is one such ASC that has reaped the benefits of a value-based arrangement for joint replacement procedures.

In June, the ASC released outcomes of its first 1,000 commercial prospective 90-day bundles, which created $15 million in savings for the payers, a new revenue stream for the surgery center and extra income to the surgeons based on a quality metric system.

Through the bundle, surgeons at the ASC performed 505 total knee replacements, 320 total hip replacements, 161 partial knee replacements and 14 total shoulder replacements. Results included a reoperation rate of 1.1 percent, a readmission rate of 1.4 percent, an infection rate of 0.3 percent and a patient satisfaction score of 99 percent.

"These results show that outpatient joint replacement is safe and effective. In fact, these results are superior to most inpatient results," said Frank Aluisio, MD, president of Durham, N.C.-based EmergeOrtho and founding member of Delta Joint Management, a collaboration of all orthopedic groups in Greensboro. "In addition, since value is defined as outcomes divided by cost, these results verify that commercial prospective bundles can achieve both improved outcomes and decreased costs. So this program is creating tremendous value."

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