Rising costs for healthcare and fragmented billing practices have always been a major concern for both patients and care providers. And even more in today’s complex healthcare landscape.
Bundled pricing promises to address these issues and improve the experience for all parties involved. That’s why the bundled pricing strategy has been gaining increasingly more interest in surgery centers nationwide.
In our recent webinar, Dr. Biraj Patel and ASC administrator, Ashley Poulos, discussed all aspects of the bundled pricing strategy with two experts, Dirk W. Carson and Becky Ziegler-Otis.
They delved into the concept of bundled pricing for surgery centers, exploring its benefits, implementation strategies, and potential impact on the healthcare industry.
View the full recording or read the crucial excerpts from the conversation below.
What is bundled pricing?
Dirk Carson: At its foundation, bundled pricing is a financial arrangement that puts all the included elements of a particular procedure together. For example, a total knee. So we're going to bring together the facility, the anesthesiology, the surgeon, the implants, and all the attendant costs to a traditional approach to that surgery in one episode, in one bundle. So we can set that definition on what's included and what's excluded. And then use that to set a market price or come up with a market price that is effective and sustainable.
But this cannot be a race to the bottom. This is about setting what the benchmark should be for the cost of care, as opposed to trying to drive down the price of the services to the point where we have to take pieces out of it that make it ineffective.
This is really about how we can provide sustainable pricing and the reimbursement that the provider community needs, but also in a way that we make it affordable for employers. It is about how to bring all of the services together in a way that serves the provider, the employer, and especially the employee, that patient, that’s so important to us.
Biraj Patel: So it's directed towards providing excellent service and fixing the condition. Not the — more services, more fees.
Dirk Carson: Absolutely. This is about reasonable pricing for a set of services. In one sense, we're helped by the current system where we have to find things in terms of ICD-9s and CPT codes. That gives us a starting place. But once we get that starting place, that becomes more of an anchor for us that we need to jettison.
We need to be thinking from a bundle standpoint. When I open the shoulder, I may have a total, I may have a partial, but almost anything else that I'm dealing with should be pretty much under one umbrella. I don't want to have to open it up and say “Okay, no, this is this CPT code and not that CPT code, and therefore it's not a bundle, it's a this, or it's a that”.
We want to be able to say “It's a shoulder, folks” and we want to price it accordingly. Let's just say that half the time you have a minor debridement, and the other half you do significant debridement. Fine, we'll take that, cut it in half, we'll pay the 50% rate in between the two of them for every single surgery. And now you don't care, I don't care, because over time, it's going to all work out for everybody's purposes. But in a much more simplified, much more understandable way.
Ashley Poulos: And does it get to the point where surgery centers have that volume that justifies the medium between the two?
Dirk Carson: That's the goal. If it doesn't work out over time, we can study that too. You're still going to have some of the medical records from what happened. If there need to be true-ups at different points, or we need to move the needle one way or the other to make it more attractive or more sustainable, then that's what we do.
Read more - Bundled pricing in surgery centers
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