Illinois Bone & Joint Institute CEO: Preventive care is on the horizon for CMS

Illinois Bone & Joint Institute CEO André Blom spoke to Becker's ASC Review about CMS' proposal to add total joints to the ASC-payable list and what it means for his organization.

Note: Responses were lightly edited for style and clarity:

Question: In your opinion, what are the most surprising aspects of CMS' proposals for outpatient payment in 2020 and why?

André Blom: I'm not surprised. We have been part of the Bundled Payments for Care Improvement program since 2014. Within the context of that program, we have the ability to meet with CMS on a pretty regular basis. It became very evident over the last three to four years which direction they were going to go. They’re staging it a little bit earlier than I would have [predicted] because, from an actuarial standpoint, this is new for them. They don't have data like they do for inpatient procedures over multiple years. So, I think they're fully committed to the shift in site of service and that they're going to push more aggressively for it.

Q: In what ways could CMS' proposal to add total joints to the ASC-payable list affect Illinois Bone & Joint Institute and the way you run your business?

AB: We welcome the change. What we've seen over the last five years or so is that patients that come and see us for total joint replacement — whether it's knee or hip — have very varied clinical manifestations. Some of them have the ability to recover overnight, some can go home the same day, and some require a longer stay due to comorbidities or other components of care. The program in the past was actually inflexible, especially from a payment paradigm. What this change allows us to do is to appropriate the clinical rehabilitation program and recovery program around the site of service better.

This change from CMS plugs in really well with our OrthoSync program, which is our value-based MSK management services and the vehicle from which we entered the BPCI program. We use a risk-prediction algorithm to assist patients in their recovery. That risk algorithm that we use is seamless when applied to inpatient, outpatient and even ASCs. We also do a significant number of commercial bundles within the OrthoSync program. So, it fits well into what we've already had up and running and the ongoing transition to high-quality care moving to the ambulatory environment.

Q: Do you anticipate a volume increase if this proposal takes effect?

AB: We have seen higher volumes, and we believe this will continue because of how we've applied the OrthoSync program since 2014. The premise of the program is that the most important part of recovery is transition of care — when you leave the hospital, when you initiate care at home, when you go to an outpatient environment, if you need to be at a skilled nursing facility. Those elements were critical [to] the program. With the flexibility that CMS now gives us, and in the partner network that we use, we're able to [have] more options for patients.

Q: What are your thoughts on the proposed payment rate of $8,639.97 for total knee arthroplasty in outpatient settings?

AB: Our position is not really to look at cost as a defining factor for where a case gets done. We participated originally in the inpatient program simply because we understood that the total cost of care for a total joint replacement was too high. We gladly partnered with CMS to change and shift the market on that. I don't think that a price point is going to dictate where and what we do. I think it's [all about] providing the care in the best location for the best ultimate outcome.

Q: What advice do you have for other practices in the wake of this proposal?

AB: I would tell any practice and physician to ultimately pick the right clinical location for the best possible clinical outcome per patient. We believe highly that care in the future should not be protocol-based, but that it should be individualized to patients. Individualized care should be at the forefront of our decision-making. I would tell all other practices [not to] make policy-based decisions on this one item.

Q: What do you think is next on the horizon in terms of CMS proposals/reimbursement changes for orthopedics?

AB: We're bullish on preventive care. Some of the questions and some of the guidance we get leads us to believe that may be [next for CMS]. We established a program at IBJI three years ago or so called OrthoHealth, a four-part metabolic disease management program, which we use for our bundled payment program to assist people with things like weight loss, general nutrition and exercise, so that we can get a better outcome following surgery. I think that's going to become more mainstream. Instead of just having a fee-for-service mindset where the government asks you to partner with them in saving money, I think they're going to want to partner with you in being a true healthcare provider from an avoidance standpoint rather than just a production standpoint. I think that's what's coming next.

Interested in participating in future Becker's Q&As? Email Angie Stewart:

More articles on orthopedics:
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Dr. John Martino completes new ASC's 1st outpatient joint replacement — 5 details
3 ASCs adding total joint replacements this summer

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