How Southern California Orthopedic Institute shifted total joints to ASCs using bundled payments — 5 insights

Van Nuys-based Southern California Orthopedic Institute CNO Rashel Campos, RN, BSN, spoke to Becker's ASC Review about how using Global 1's bundled payments structure helped the organization move total joint and spine procedures to its outpatient centers.

Note: Responses have been edited for length and style.

Question: What are the benefits of a bundled payment model in your ASCs?

Rashel Campos: We're an orthopedic practice and we have physician-owned centers. Global 1 has been able to secure bundled payments, providing us the opportunity to do outpatient joints. People have been following the Medicare model: if you approve the code, we'll approve the code. Global 1's been able to secure coding and bundled payments for total joints that allows you, financially, to do it. Other places have given you codes that allow you to do the surgery, but the code's not reimbursed enough with the implant and contracts you had in place. So, Global 1's been able to secure payment for total joints, [which is] allowing us to move our total joint and spine programs into our centers.

Q: How many cases have you done under the bundled payment model? How long have you been doing the bundled payments?

RC: We've been doing the bundled payments with Global 1 since 2015. Our most recent [ASC started] in 2018. Everything that was Blue Shield now goes through our bundles. We were doing, on average, about 25 cases a month in 2018 [at The Center for Orthopedic Surgery]. So, we're doing [around] 250 to 300 in both of our bigger centers that have been doing the bundles for longer. Our other center [Bahamas Surgery Center] is doing about 15 to 20 a month.

We have a total joint program and a spine program that we have been increasing [since we started working with Global 1]. This year, we're going to be doing the AAAHC joint and spine accreditation. [The bundled payment model] alone has pushed our total joint program so much.

Q: How does the bundled model help you handle implant costs?

RC: Before, let's say, take a Blue Cross or a Cigna contract. Cigna will give you so much for the code and they'll reimburse you a max on your implants, which wouldn't cover your implants. So your implant cost is eating into the profit of your joint code. With the Global 1 bundled payments, it provides a large enough margin that it's reasonable and it meets the risk factor for bringing something like that to your center. So, it's been a big motivator for us to increase our joint and spine [programs].

Q: Do you now offer total joints in all three of your ASCs?

RC: In two of our ASCs, we do totals. Our third ASC's smaller; central processing isn't large enough in that center to do joints right now. In two centers, we do total hip, total knee and spine. And our surgeons in the last year have done quite a few total shoulders as well. So, our total joint program has greatly increased.

Q: What are the important elements of a successful bundled payment program?

RC: The first thing's good communication between your physicians, your scheduling physicians' office and the surgery center. You have to have a good working relationship with all three because everybody has to agree to the bundle. Once you've implemented the bundle, there has to be good communication so everyone working for you understands the bundle [and] what insurance payers go through the bundle.

We have weekly meetings with our ASC teams so that we review cases that we bill through the bundles. You have 20 different payers — between your primary commercial insurances, Global 1, worker's comp, Medicare — so, we review all of our cases to see what cases could go through the bundle.

To participate in future Becker's Q&As, contact Angie Stewart at astewart@beckershealthcare.com. For a deeper dive into ASC industry trends, attend the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC in Chicago, June 13-15, 2019. Click here to learn more and register.

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