figure out where they'll get the best post-op care. But CMS has curious-
ly put hospitals in charge of the bundled payments when it's not the
hospital that makes most of the crucial decisions about where a
patient will best recover. Instead, effective and efficient surgeons work
with patients before hospitalization to decide where they should con-
valesce. That decision is based on numerous factors — the care avail-
able at home, the patient's age and overall health — and should be
made weeks before the procedure, not the day of or the day after sur-
gery.
On the other hand, private payers' bundled payments focus on giving
surgeons the opportunity to think about not only the best option in
post-op recovery care, but also where the surgery should take place.
That's the key decision we want the healthcare delivery system to
make. Private payers encourage physicians to decide how to achieve
excellent outcomes at the lowest total price point. In many instances,
that occurs at outpatient facilities.
Medicare doesn't reimburse for total joints performed in the outpatient
setting, because it makes decisions based on political pressure instead
of facts, logic and empirical evidence. In this instance, private payers are
setting the example. The private sector's bundled payments don't lump
all joint replacements together at the same reimbursement rate. They
adjust payments based on the procedure and the health of individual
patients. The private sector also understands that encouraging site-of-
service selection — instead of attempting to play catch-up on the back
end by managing the cost of recovery — is how you begin to lower the
price of the procedure.
Supporting the outpatient option
Surgical leaders must closely observe how the CJR program works
On Point
OP
6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 6
