4 things innovative systems do to excel in bundled payments


Bundled payments are having their moment in healthcare, with commercial and government payers alike inking deals to make providers financially responsible for an entire surgery or episode of care. These bundles are "fundamentally different" than how providers have been paid before, according to Jeff Peters, CEO of Surgical Directions.

During the Becker's Hospital Review 7th Annual Meeting in Chicago, Mr. Peters addressed these bundles and what high-performing health systems are doing differently to drive success.

"What's key to driving it is surgeon behavior," he said, and putting gain sharing programs into place for surgeons is a great place to start to get physician buy-in. These programs can increase surgeons' and anesthesiologists' compensation by 50 percent, he said.

Beyond offering gain sharing, here are four more things innovative systems are doing to excel at bundled payments in a value-based world.

1. Get physician leadership. "There's got to be somebody who is so emotionally attached to the program's success that's clinically respected, that's demonstrated leadership and can get results, that's the enabler to make it work," Mr. Peters said.

Surgical Directions has seen success when the physician champion is a clinically active surgeon who is well-respected and can drive their peers to action. He cautioned against using a department chair as the champion, because they are typically more privileged and not always as clinically respected by peers, he said.

This chosen surgeon can lead a surgical services executive committee, which is given responsibility for the bundle, or the entire OR if the facility is moving entirely to value-based payments.

2. Change the structure of perioperative services management. Instead of having an OR director, who has limited responsibility outside of the operating room, successful organizations have created a new position that oversees an entire episode of care, from scheduling to post-op and everything in between. Mr. Peters gave an example of one Chicago-area system that created a vice president of surgical services position to fill this role.

3. Establish process improvement teams. These teams focus on mapping out a patient's entire experience, from checking into the hospital to after hospital discharge to identify potential problems and mitigate negative outcomes by planning an intervention.

4. Involve anesthesia. With the right anesthesia and pain control, patients can ambulate sooner, which enables them to go home sooner. "That's really dramatically reducing the cost," Mr. Peters said, especially because 40 percent of the cost of a joint procedure happens post-discharge, according to Surgical Directions. "If we can manage the pain and get the patient to go home…we can cut our costs 40 percent and improve out patient outcomes."

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