More ASCs are considering bundled payments as a part of their strategy. Three ASC leaders spoke with Becker's ASC Review on addressing obstacles with bundled payments.
Note: These responses were edited for clarity and brevity.
Mark Spina. Executive Director of Ambulatory Surgery Centers of America: Regarding bundled payments, the biggest challenge for ASCs is getting all parties that produce a bill during an ASC procedure — primarily the ASC owners, the surgeon, anesthesia and pathology — to agree to a bundled payment for their services.
If the commercial insurance company is offering a total bundled payment of $5,000 for the procedure, how is the payment going to be divided among the participants? No one will want to take a reduced payment. One assumes the insurance company would be offering more case volume in exchange for the bundled payment, but obviously that won't in fact be known until after the contract is signed and the bundled payment rate has been locked in.
Meredith Warf. Administrator of Madison (Miss.) Physician Surgery Center and Mississippi Sports Medicine and Orthopedic Center (Jackson): With bundled care, the surgery center is now responsible for coordinating postoperative services and data collection in conjunction with the surgeon teams for several months after the operation. The data collection day of surgery is easy, it's the next several months that can be more of a challenge.
The ASC now also has to ensure all strategic partners, including home health and outpatient physical therapy, are aligned with the plan of care and understand the goal of reducing costs while improving outcomes. For us, this included two core leaders of our bundled joint and spine programs who lead on this front.
The other challenge is administering the claims when the ASCs are paid — often these bundled payments include four or five strategic partners who must have claims disbursed from the surgery center according to the way the contracts are set up. Tracking these patients, claims and dollars on a large scale is another added administrative burden for ASCs. All that said, we believe the bundled procedure volume will continue to increase even faster than in the past. These challenges are also the biggest opportunities for ASCs in the near future.
Teleatha Mortimer, BSN, RN. Administrator of Bloomington (Ind.) Endoscopy Center: As far as bundled payments, we lose money in many cases because it doesn't cover the costs of extra items used even though they are necessary. If hospitals can line-item bill, why can't ASCs?