Mr. Uba says Excelsior's surgery center benefits from operating in a
market with 3 strong local payers — Blue Cross Blue Shield of
Western New York and the HMOs Independent Health and Univera —
interested in the potential of outpatient joint replacement. The insur-
ers had seen other cases shift from the inpatient to the outpatient
arena and were understandably excited about paying significantly less
than what they pay for joint replacements performed in the hospital.
A group of surgeons and Mr. Uba met with the insurers to educate
their medical directors and directors of contracting and network
about minimally invasive techniques, regional blocks, perioperative
pain medications, advancement in post-op pain control and accelerat-
ed rehab protocols. "They wanted to understand why and how outpa-
tient total joints are possible, and needed proof that the procedures
are safe and effective," says Mr. Uba.
The negotiations centered on bundled payments, which, Mr. Uba
says, eliminate tediously negotiating fees for surgeons, anesthesia
providers, the facility, rehab, recovery care, implants and supplies.
Excelsior now has bundled payments in place with all 3 payers. The
bundles cover surgeon, facility and anesthesia fees, all aspects of peri-
operative care, a 2-day post-op stay in an offsite recovery suite, 15 phys-
ical therapy sessions and 90-day recovery care.
Excelsior performs the procedures for about 30% less than what the
$15,000 to $30,000 local hospital charges. "We can divide the single
payment any way we want," explains Mr. Uba. "It's enough to cover
our costs, with some margin left over.
Forward thinking
Patients seeking joint replacements are significantly younger and
healthier than when Dr. Stoeckl trained 10 to 15 years ago. Younger
patients interested in maintaining an active lifestyle and quality of life
J A N U A R Y 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 1 5
