so with confidence knowing that you totally understand your marginal
opportunities. Offer the payers a reasonable discount — 10% to 15%
less than the all-in reimbursement they currently pay for 90-day
episodes of care for inpatient joint replacements performed in local
hospitals. Insurers will likely be interested in the opportunity to pay a
lower flat fee and offload some of the risk of care to your group. The
key is to offer a competitive, but fair, price — and have the quality data
to support the position that your group offers the highest value for
total joint replacement patients in your region. If you understand your
true costs of care, constantly manage your expenses and build in rea-
sonable margins, there will be savings for insurers and profit for your
group in the bundle.
5
Look for cost-saving opportunities
The place to cut costs is not in your data collection and manage-
ment program. It's essential to have at your disposal clean, credible
and actionable data in 3 categories: cost, quality and patient-report-
ed outcomes. With this information at your disposal, you'll be able
to identify money-saving opportunities. Review the data on a weekly
basis to look for outliers and provide constant feedback to providers
who stray from the standardized care they need to provide.
Inevitably, more outliers and less standardization result in more
expensive care. Conduct detailed annual reviews of your clinical
protocols and outcomes to further eliminate waste and unnecessary
services.
Proof positive
A year after we implemented our bundled payment program, our
patient satisfaction scores jumped from the 84th to the 99th per-
centile, readmission rate dropped from 7% to 2% and implant costs
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