Outpatient total joint 90-day bundled payment program hits 300+ cases: 4 Qs with Dr. Steven Lucey

Surgical Center of Greensboro (N.C.), a Surgical Care Affiliates facility, is a pioneer for outpatient total joint replacements and physician-driven bundled payments at ASCs.

Last year, surgeons at the center performed 250 total joint procedures, and since launching its outpatient commercial 90-day prospective bundled payments in 2017, the group has completed more than 300 procedures. The group first contracted with Blue Cross Blue Shield of North Carolina and later inked deals with Aetna and Cigna, as well as a regional payer. 

The physicians launched a consulting business, Valere Bundled Solutions, to focus on building the relationships with executives in charge of value-based initiatives. The group will host a summit in Greensboro in March that hopes to launch bundled agreements in the future. Here, Steve Lucey, MD, discusses how his group developed bundled payments, lessons learned and where he sees these relationships headed in the future.

Question: What was the process for developing the 90-day prospective bundled payments? Why did you decide to go that route?

Dr. Steve Lucey: The Bundled Payments for Care Initiative experience taught us that controlling the entire 90-day episode is important to control both the anchor episode and the post-acute spend. We also learned that a prospective bundle gave us far more control over the spend from a business standpoint and focused us on standardizing practices.

Q: What challenges have you come across now with around 300 cases completed? Did anything surprise you?

SL: There were two key challenges. First, getting the payers to the table with good historic spend information to negotiate. They haven't had good software solutions to do that. And second, we needed an informatics platform to do case management as well as run the financials of the bundle, which includes paying downstream providers and quarterly reconciliation with the payer. We ended up designing a software platform uniquely to do this, called ValereCARE. The only surprise was that payers weren't more flexible and nimble to change to this value-based paradigm.

Q: How do you see bundled payments and payer relationships evolving with ASCs in the future?

SL: It is going to grow fast once the payers and providers figure out how to get to the table and gain alignment. We have formed a consulting company to help that very thing happen, Valere Bundled Solutions. In fact, we are hosting a Summit on Outpatient Bundles where we will bring joint surgeons and payers together to facilitate these arrangements in other markets so they can experience the same success we have had locally.

Q: What do surgeons need to know as they prepare for bundled payments? How can they set themselves up for success?

SL: They need to lead the discussion and take ownership of the bundle business. They need to realize the clinical decisions they make are, by default, also financial decisions. There are other complexities, such as insuring the bundle, standardizing pathways and risk assessment that they will need to learn as well.

The 2nd Summit on Outpatient Joint Bundles will take place March 28 and 29 in Greensboro, N.C. For more information, readers can visit www.valerebundledsolutions.com.

To participate in future Becker's Q&As, contact Laura Dyrda at ldyrda@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 13-5, 2019. Click here to learn more and register.

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