this data, too. It'd be much easier if CMS finally determined to allow
[total joints] at ASCs."
Dr. Gonzales says commercial payers often want to contract with
surgeons' groups because they're in the best position to coordinate
care across the full episode, from the time the patient enters their
clinic with a referral for surgery to the time the patient is up and
moving and progressing toward successful recovery.
It's essential to determine what services and providers will be
included in the bundle, and engage the providers in charge of those
elements of care. Put together a tight list of all the services that are
part of care coordination, focusing on providers that you really trust
to provide consistent quality and affordable care, suggests Dr.
Gonzales. "If you have all those components, you should be able to
put together a solid program with any payer," he says.
Ultimately, the ability to coordinate care across multiple providers is
key. "If you don't have control over what's happening with patients
[outside of your facility], your ability to operate in a bundled payment
can be very limited," says Dr. Gonzales. "It won't really work out for
you."
Mr. Uba says Excelsior was well-positioned for bundling. "We run all
of the ancillary services — urgent care, MRI, imaging, DME, physical
therapy — and we have an ASC that's 100% owned and controlled by
our physicians," he explains.
That means his group has oversight of the entire means of produc-
tion to do outpatient joints. "Managing risk has been easy for us,"
says Mr. Uba. "If you don't know what you're doing under the bun-
dle, things can go awry pretty quickly. It needs to be tightly man-
aged. Your processes need to be crisp."
For that reason, Excelsior has several pages of flowcharts that out-
line patients' care processes that are implemented as soon as sur-
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