700 joint replacement cases a year at the hospital is quite another. Dr.
Lucy's group sold them on doing cases in an outpatient surgery center
and the financial and operational benefits of standardizing the care
pathway.
"The bundled payment model let us align incentives amongst the
patient, the doctor, the insurance company and the ambulatory cen-
ter," says Dr. Lucy, "to create a 'double whammy' of value: improving
outcomes and decreasing cost."
Pillars of success
A bundled program can crater under the weight of excessive costs. In
a study published in February in JAMA Internal Medicine
(osmag.net/PjvRE5), Dr. Navathe and his co-authors dug deep into
the numbers at the voluntary Medicare total joint bundled-payment
program at Baptist Health System in San Antonio. The final account-
ing was nothing short of miraculous.
Between 2008 and 2015, the system shed $5,577 (20.8%) in costs for
each total joint case. It attributed the savings to standardizing the plan
of care across patients, including the type of implants used in their
cases. Indeed, much of the savings came in implant and supply costs.
• Implants. Average implant costs decreased 29% from $6,636.42 to
$4,715.74.
• Supplies. Average supply costs declined 60% from $1,226.94 to
$498.46.
OR costs declined 34% from $1,240.98 to $829.43. Readmissions, ER
visits and cases with prolonged lengths of stay all declined significant-
ly.
"The implant is a big part of the cost of the procedure," says Dr.
Navathe, "but by creating an alignment within the system, they cut
costs [nearly] 30% just by negotiating together."
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 • M A Y 2 0 1 8
