Applying bundled payments to perioperative services: 3 major takeaways

Bundled payments have the potential to improve a hospital's perioperative efficiency and quality, as well as maximize revenue for both hospitals and surgeons.

Alecia Torrance, RN, senior vice president of clinical operations for Surgical Directions, and Joseph Bosco, MD, vice chairman for clinical affairs at the New York University Hospital for Joint Diseases' Department of Orthopaedic Surgery, discussed applying bundled payments to the operating room in a recent webinar.

"Healthcare leaders' role today is to improve the value of perioperative services, and the only way you can do that is by improving the quality of care and reducing the cost," said Ms. Torrance. "It is very important that you do not allow the cost constraints to affect your quality outcomes, and that was one of the things NYU was so impressive in [handling]."

Ms. Torrance and Dr. Bosco outlined three things hospitals should keep in mind when applying bundled payments to perioperative services, summarized below.

1. Form a collaborative governance structure. According to Ms. Torrance, one of the most successful strategies Surgical Directions and NYU have used thus far to transform perioperative services is to put in place a collaborative perioperative governing body, called the Surgical Services Executive Committee. The committee works like a board of directors to bring together surgeons, anesthesiologists, nursing, senior leadership and performance improvement teams to implement new perioperative services and launch the bundled payment initiative, all while aligning incentives.

2. Understand that risk factor modification is justified and necessary. When surgeries are elective, hospitals and physicians are "well within their ethical right" to delay or deny a patient surgery if they are too high of a risk. Hospital resources are limited; operating on sick patients may preclude the organization from giving care to patients who are not as sick because they run out of money or have complication rates that are too high, according to Dr. Bosco.

"The autonomous patient should be able to make medical decisions on his or her own and…do what they think is best for them," said Dr. Bosco. "But sometimes, what's best for a patient may not be what's best for your hospital or society."

3. Consider outside help resources to optimize patient risk, reduce readmissions and create pathways. To survive in a bundled environment, Dr. Bosco notes many hospitals could benefit from engaging outside consultants to create pathways that will mitigate patient risk. As for readmissions, NYU found keeping patients in the hospital longer to avoid sending them to post-acute care facilities helped to control costs and reduce the likelihood of readmissions.

"To reengineer hospital process and turn your hospital from a fee-for service arrangement…to a value-based process where everything is done with an eye toward value, it takes a lot of external support," concluded Dr. Bosco.

 

To learn more, download the webinar presentation slides here. View the webinar by clicking here.

Note: View archived webinars by clicking here.

© Copyright ASC COMMUNICATIONS 2017. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Top 40 Articles from the Past 6 Months