Emphasizing as it does a value-based approach to care, the bundled payments model has a lot to offer not just the healthcare industry in general, but also the physicians working at the heart of it.
By basing compensation on efficiency and quality of care — as opposed to quantity — the bundled payments model gives physicians the power to practice in the style and setting they find most fulfilling. For motivated physicians, this means an opportunity to pursue newer, better financial incentives, and to regain a focus on patient care — the purpose many entered the field of medicine in the first place.
Bundled payments offer “a whole new avenue of medicine,” renowned orthopedic surgeon Frank Aluisio, MD, recently told us. “It’s probably one of the first things ever that will simultaneously improve the patient experience, improve patient outcomes, and yet, operate at a far lower cost than what’s going on now.”
If that list of benefits sounds familiar, it should. In his description of Valere’s approach to joint replacement care, he’s basically describing the “triple aim of healthcare” — a prized, but often elusive, three-tier standard for improving the American healthcare system.
A Model for Physician-Run Outpatient Arthroplasty Groups across the U.S.
As a model for how physicians can make the most of this new type of practice, Dr. Aluisio and three other North Carolina-based orthopedic surgeons created the Valere Bundled Solutions, a group specializing in guiding physicians through the bundled payments model, and sharing the personal and professional rewards it can offer.
“In 20 years of practice, this is the most rewarding experience I’ve had,” Dr. Aluisio told us. “I feel like I’m taking more of a role in every single part of my patients’ care, and my patients are having a better experience because of that.
“We’re really the first group in the country of physicians who have created and directed an outpatient arthroplasty bundle,” he added. “It’s revolutionary.”
For providers unsure of their ability to successfully run a bundle, Valere serves as a guide to walk them through the process, step by step. And for those uncertain about handling the risk involved, the Valere group offers a model for transforming that risk into opportunity.
“The unique aspect of this, compared to other bundled arrangements, is that this is physician directed and physician run, as opposed to the other bundles that are either hospital run or surgical center-run,” Dr. Aluisio explained. “Our bundle covers the 90-day episode of care, while other outpatient arthroplasty arrangements generally only cover the day-of-surgery costs.
“In those circumstances, participating physicians don’t have any risk involved if there’s a complication, but they also don’t have the potential for an additional reward. With this arrangement, we’re assuming all the risk, but there’s more of a potential for rewards for a well-run bundle.”
Despite this risk, Dr. Aluisio is confident that the process of outpatient joint care is best run by the surgeons. “It’s something that we feel should be directed by physicians, because we’re the ones most directly involved with the patients,” he said. “We’re the ones who direct their care, before, during and after the time of their surgery.”
A Model for Achieving ‘Tremendous’ Patient & Surgeon Satisfaction — with Zero Readmissions
That high level of clinical knowledge and patient rapport have been key to Valere’s success. “We knew we could make the bundled payment process work based on our experience with the Medicare BPCI program, and we knew we could extrapolate that to make it work with younger, healthier patients,” Dr. Aluisio said.
“In our first year, the level of patient and surgeon satisfaction was tremendous. We had zero hospital readmissions, and no significant complications,” he added. “Based on our initial experience, we feel that we have provided higher value care to our patients by providing equivalent or better-quality results at lower costs.
“Every patient that’s been involved in this bundled program so far has said that they’ve felt like they’ve gotten better service,” Dr. Aluisio continued, attributing this patient satisfaction in large part to superior case management. “Case managers act as a conduit between the patient and the surgeon. There’s a case manager looking after every single step of the process … patients are essentially getting concierge service,” he said.
Although Valere specializes in reducing post-acute costs specific to outpatient joint replacement care, Dr. Aluisio said that he and his colleagues “also feel that our model is adaptable and potentially applicable to other episodes of bundled care in orthopedics, and potentially other specialties. We can set the program up for physicians, including the informatics platform, and help them run it, so their involvement and level of work in creating the program is minimized,” he explained.
“It took us two years to develop this program from head to toe,” he added. “We started from scratch, built all the protocols for surgeries and postoperative care, and worked directly with insurers and surgical centers to set this up. We negotiated with physical therapists, home health agencies, informatics companies and implant companies to control costs and maximize efficiencies.
“We’ve already done the work, and we can work as consultants to help others set up similar programs. Two critical aspects are tracking outcomes, and managing payment to all the other providers, and we’ve also developed software to address that.”
The bottom line? “The bundled model we have utilized, with physicians controlling the care and costs, has the potential to be transformative in the future by providing high-quality care at lower cost and potentially bending the health care cost curve in a meaningful, more affordable direction.”
Dr. Aluisio is a board-certified orthopedic surgeon and a team member at Greensboro Orthopaedics, with whom Reflexion has a working relationship.