The hospital also focused on
adhering to guidelines that
decreased the need for blood
transfusions, utilizing staff more
efficiently for cases and reducing
the length of stay in the hospital,
which all helped to cut costs.
Plus, since bundled payments
require the provider to look at the
total cost of care — not just the 2-
hour procedure itself — they
found ways to standardize post-op
care and create savings. To do
this, the hospital decreased the
use of inpatient nursing facilities and physical therapy services and
instead shifted more patients to home health agencies, outpatient
physical therapy or at-home physical therapy.
"I think the No. 1 mechanism for bundled payments is creating align-
ment and incentives among physicians and hospitals and Medicare,"
says Dr. Navathe. "That can in turn make care more patient-centered
and higher quality."
The Big 3
Dr. Kusuma lists 3 key things facilities need in order to be successful:
• Technically skilled surgeons who are up-to-date and well-trained
on the latest minimally invasive techniques;
• strong patient selection criteria that focuses on patients with few
or no comorbidities; and
• a consistent patient management pathway that takes into account
their care from the day they sign up for surgery to 90-120 days post-
M A Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 4 9
• VALUE-BASED PAYMENTS Orthopedic surgeon Stephen
Lucey, MD (far left) and his colleagues own a surgery center
and oversee their own total joint bundled payments.
