Harris Meyer writes in Modern Healthcare about how bundled payments are gaining popularity with orthopedic surgeons even as the Trump administration has thrown  some cold water on the reimbursement approach when applied to Medicare patients.

For example, Dr. Amol Navathe, an assistant professor of health policy and medicine at the University of Pennsylvania, told Mr. Meyer.

“One of the nice things about bundled payment is it can provide a direct financial reward for physicians to work hard on aspects of care that can be difficult and require coordination with the hospital. It’s important that physicians be engaged and bought in.”

Mr. Meyer writes:

“While many hospitals and physician groups are working on improving care outside the CMS’S bundled-payment programs, the financial incentive of meeting a fixed cost target for an entire episode of care has spurred a stronger collaboration between these often-competing players. That’s true even for hospitals and medical groups that have not established financial arrangements in which doctors get bonuses for meeting cost targets, known as gain-sharing.”

“Another key to the success of bundled payment is helping surgeons prepare patients and their families for the surgery and recovery phases. That includes working with patients to improve their health before surgery to optimize outcomes, such as encouraging them to lose weight or quit smoking. Many orthopedic groups have invested in hiring nurse practitioners or surgical assistants to do this patient education work.”

Of course identifying physician leaders to facilitate the move to bundled payments is crucial:

“At each hospital, the physician leader convened a kickoff meeting with the doctors and other clinical staff involved in joint replacements to discuss how to streamline the pre-surgical, inpatient and post-acute processes and determine what resources were needed to achieve that. That was followed by multiple meetings to design and test the new {bundled-payment} model and offer any support physicians needed in their offices.”

Mr. Meyer is writing about hospitals but  hospital bundled-payment lessons would apply to out-of-hospital surgeries, too.

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