their services, which account for a significant cost driver during the
post-op care of joint replacement patients. Controlling these costs is
therefore a major opportunity to create added value to the bundle.
Determine the amount you'll pay your physical therapy provider or
homecare nurses, the outcomes you expect patients to reach during
rehab and how many therapy sessions it should take to achieve the
goals. For example, as measurable outcomes, you can stipulate that
patients safely climb stairs on post-op day 1 and achieve 90 degrees of
flexion by 4 weeks post-op.
Demanding specific outcomes for a set fee will encourage your
physical therapy provider to streamline their care. If you experience
pushback, respectfully inform them that all healthcare resources are
being stretched and providers are being squeezed to deliver better
outcomes at a lower cost and with fewer complications. If they want
to participate in the joint replacement boom, they'll likely work with
you and do what it takes to achieve your desired results and move to
higher value services.
3
Define shared and non-shared costs
Implementing a bundled payment puts you in position to control all
aspects of a patient's care. By doing so you assume some financial risk
for covering so-called preventable adverse outcomes. Fortunately, there
are ways to allay some of that risk. For example, contract language can
reflect that your group will not cover additional complication costs
incurred by unapproved or deliberate deviation from the bundle's stan-
dardized clinical protocols.
Cost overruns due to complications or unforeseen developments,
however, will occur. Most often they occur at the fault of no one
involved in the episode of care. Again, there are ways to lessen the
financial risk to your group. First, for small overruns — claims less
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