At Becker's ASC Review's 24th Annual Meeting: The Business and Operations of ASCs in Chicago on Oct. 27, Deirdre Baggot, PhD, principal at ECG Management Consultants, shared thoughts on the future of bundles in the ASC space.
Risk-based contracting in the ASC space
"Anything in the ASC space in terms of risk-based contracting is still very much in the innovation phase," Dr. Baggot said. "Our team has been studying for eight years and I think we're better but I still feel like some days we're at [version] 1.0 or maybe, at best, 2.0.
"So as you think about your organization and think about doing a bundle in an ASC, if you're waiting until you're ready, you will be at a strategic disadvantage."
"This is 100 percent the story of being first matters more than being perfect. You may never feel like you're ready but the truth of the matter is if you look at bundle payments or at care improvement — and [CMS] just released the third year evaluation — if you look at [the Comprehensive Care for Joint Replacement Model], you actually don't have to be perfect. You can do minor and small changes and see it works really well with bundled payments."
"… These value-based payments models are not perfect, but they're one of the most powerful ways to integrate with your physicians today."
On cherry picking cases
"Do you ever hear hospitals say [ASCs] are cherry picking?" Dr. Baggot said. "We have a moral obligation to not do things that put patients in harm's way and the truth about joint or any procedure in an ASC that has a lower acuity is that fall rate, infection rates are both higher in a hospital environment."
"So what I like about total joints in an ASC environment in a viable population is that we're actually doing the right thing for the patient."
"When I think of cherry picking, I think the hospitals have been cherry picking and the right thing to do for patients is to put them in the right environment."
"There's so many reasons an ASC makes sense for patients. … The truth of the matter is, you're actually doing what's right for the patients, which is to put that patient in the right center and the right setting."
"[However, ASCs} can't have it both ways. [ASCs] can't say [they] want to compete on price with hospitals and then simultaneously say because the care is better and the patient experience is better, [ASCs should] be paid a premium. At the end of the day, we have a moral obligation to patients."
Commercial payers' views of bundles
"Of the studies from the last couple year[s] on the commercial side, the outcomes are really good," Dr. Baggot said. "They've been in orthopedics so I think that's relevant to you and the future and where you'll sit going forward."
"[Blue Cross Blue Shield] and UnitedHealthcare are the most active in this space. If you're not having conversations with your payer in this market, I guarantee your competitor is."
"Most of the data on these commercial bundles has been quite good. Keep in mind the commercial population is healthier, so they have less needs in terms of post-acute commercial management, but the savings to these health plans has been meaningful for the last several years so I expect to see more of it."