done to them, and I can't predict in any
way what my exposure is going to be,'"
he says. "'Give me some ability upfront
to predict what my costs are going to
be like. Now that's worth something to
me.'"
Dr. Casale says that during talks with his insurance team, they also
noted that if something goes wrong with the patient, that patient has
to come back to the facility to get something redone or an infection
treated that was preventable, and the insurer is getting billed again.
"I'd never do that if it was my refrigerator or my washer," says Dr.
Casale. "I'd call you and say my refrigerator doesn't work, and I
wouldn't pay you again to fix it." Same, he says, should be the case
with healthcare.
That got insurers on board. "They said, 'Transfer some of the risk for
bad outcomes from me, who has nothing to do except write checks,
to somebody who has some control over preventable bad things, and
you have my interest,'" he says.
If you're looking to start a warranty program, talk to your insurers
about creating bundled pricing, which will include the cost of every
part of the surgery from the time the decision's made to post-opera-
tive pain management based off of predictable outcomes you deter-
mine with your team.
To cover the warranty, include in that bundled pricing half the average
cost of readmission and the management of complications for that par-
ticular surgery. For example, if you had 100 patients and 5 had compli-
cations that cost $1,000 each, that would amount to $5,000 in expenses.
If you divide that between 100 people, each would pay, in full, $50. But,
under warranty, that number would be divided in half, thus amounting
to all patients paying $25 rather than one paying $1,000 for their compli-
J A n U A R Y 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 2 3
"We haven't had to
make good on the
warranty. Really, it's
all about predictable
outcomes."
