What Should An Orthopedic Staff Know About Bundled Payments

Orthopedic surgeons don’t get into their profession for the thrills of accounting and invoicing, which may be part of the reason why there is so much confusion surrounding who should pay what. Bundled payments were recently introduced to healthcare as a way to ensure medical practices can perform their necessary duties without worrying about being reimbursed. Simplifying the payment structure is possible through bundled payments, but the process is more complicated than it seems.

The Basics

Bundled payments no longer list every service a patient uses but determines a set dollar amount to a given procedure in a given area. It strips away the nickel-and-dime model and instead focuses on assigning a single price for the length of the patient’s entire stay. Doctors are in charge of keeping their costs under the reimbursement threshold, meaning no unnecessary tests or extra procedures.  It allows doctors to oversee patient care from start to finish which translates to better surgical outcomes.

While a complicated surgery in Beverly Hills will have a different bundled payment than that of an out-patient procedure in Cleveland, the overall cost of both patients’ bills should go down. It has proved popular with insurers, providers, and patients alike. It’s been implemented (with some degree of controversy) in the public sector and it’s working its way into the private sector as well.

Current Events

In the DC area, The Centers for Advanced Orthopaedics is currently working on a model to offer bundled payments for seven common surgical procedures (e.g., total knee, rotator cuff, etc.) They expect to complete their negotiations with Blue Cross by the end of this year. Humana is currently expanding services for their Medicare Advantage members who will undergo knee joint or total hip replacements.

The healthcare payer will partner up with 8 different surgical groups in the Indiana and Kentucky area. Insurance companies are looking forward to a higher rating of care coupled with a lower overall bill. However, many hospitals around the country who have been mandated to participate in Medicare bundles are fighting the law, stating that their reimbursement rates are too low and the financial risk is too high.

The Future

There’s a lot of contention happening right now in every sector of the healthcare industry, so the future is hazy. As politicians continue to clash with professionals, there will no doubt be a lot of opinions on both sides of the aisle. While many people champion bundled payments as a way to keep everyone’s costs down without compromising the level of care, others worry that patient care is ultimately too variable to put a single price on any given procedure.

Everyone will react differently to their treatments, so attempting to contain it with one price is ultimately futile. What is clear though is that orthopedic practices are a prime candidate for bundled payments. The resources it takes to perform the surgeries can be predicted with a certain degree of accuracy, which is why all staff in this field need to pay attention.

It’s not easy to keep up with billing changes for any industry, but having an idea of what’s to come can make it easier. When it comes to choosing EHR software, make sure it’s flexible enough to handle the changes that may be coming down the pipeline.