4 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 9
Before negotiating bundled payments with commercial payers,
calculate how much it would cost to provide services in the bun-
dle and your desired reimbursement rate for each element.
Include enough padding for profit and paying for unexpected out-
comes. If possible, find out what insurers are paying facilities in
your area and offer to deliver the same care with quality out-
comes for less. You'll be in a powerful position at the negotiating
table if an insurer is paying the local hospital $33,000 to replace
joints and you propose to perform the same procedures — and
take on the financial risk of delivering excellent outcomes — for
$10,000 less.
Below is a list of the basic components of a typical bundle for
outpatient total joint arthroplasty, courtesy of David Uba, CEO of
Excelsior Orthopedics in Amherst, N.Y. Only the total cost is nego-
tiated with the payers; the individual allocations are determined
by the entities providing the services.
"Insurers give us the
bundle, and we deter-
mine who gets what,"
says Mr. Uba. Instead of
paying the surgeon
$1,400 for a joint
replacement, for exam-
ple, they might give him
$4,700 because he's tak-
ing on more responsibility for the patient's care and outcomes.
They get to assign value to the entire episode of care.
Mr. Uba says bundling impacts vendor negotiations, too. "We
Surgeon's fee $4,700
Surgical Assist Fee $350
Physical Therapy (15 visits) $1,535
DME $450
Recovery Suite Nursing $1,685
Anesthesia $1,500
ASC Facility Fee $10,730
Recovery Suite Stay $2,050
Total $23,000
Bundled Payment Breakdown
PRICE POINTS
