an exceptional patient
experience, price is
inconsequential. In
addition to demon-
strating your out-
comes, you'll need a
strong infrastructure
to capture case costs
so you can set your
prices. You'll also
have to set up your
business office to
accept upfront cash
and credit payments.
Since you'll be
receiving a bundled
payment, you'll need
a clean process to
fairly divide and dis-
tribute the lump sum.
You don't want every
transparent case to be
complicated and con-
tentious, with the sur-
geon or anesthesia
provider feeling short-
changed, while you
seek to maintain
healthy margins for
your facility. Who gets
Business Advisor
BA
3 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 1 6
The bundled price for
a carpal tunnel
release (CPT 64721)
is $2,700. Here's how
we came up with that
bundled price, and
how we'd split it
among anesthesia,
the facility and the
surgeon.
• First, establish an average case time.
Based on historical data, we know that a
carpal tunnel release takes 50 minutes.
• Next, set your anesthesia hourly rate.
Anesthesia receives $500 for the 1
st
hour and
$100 for each 15-minute increment there-
after. Their reimbursement for this case
would be $500.
• Now set your facility fee by reviewing
existing cost and insurance reimbursement
rates. We calculated $1,200.
• Based on typical supply utilization driving a
45% surgeon-55% facility breakdown, the sur-
geon would receive $1,000 (which is in line
with a typical reimbursement on an insurance
case). If appropriate, we'd adjust this figure
based on supply intensity, so be sure you
know your case costs. — Andy Poole, FACHE
• 3-WAY SPLIT Anesthesia, the facility and the surgeon
each receive a set portion of the bundled price for surgery.
DIVIDE AND DISTRIBUTE
How We Split the Pot
