What is a Bundled Payment?
In a traditional fee-for-service system, individual parts of a care episode are billed to an insurance company through separate claims. Each claim must be adjudicated by the insurance company effectively leading to many bills being submitted and paid for one “product.” As an example, for a total knee replacement, the insurance company would get bills from the surgeon, facility (hospital or surgery center), anesthesia provider, visiting nurse service, and physical therapist. This would be similar to purchasing a smartphone and instead of paying one price to the cell phone carrier, the consumer would pay each company separately that contributed technology to the phone.
A bundled payment combines the total cost of a procedure into one fixed price that is known in advance of the service. One bill gets submitted to the insurance company and the payment then gets distributed to the individual components and providers of the care team by a third-party bundle manager. This significantly simplifies the administrative cost of care. Bundled payments are growing in popularity for diagnoses that have well defined care episodes such as total joint replacement.
Bundled payments can either be day of surgery only or 90-day bundles. Day of surgery bundles include the facility fee, surgeon fee, implant fee and all other durable medical and pharmaceutical items, anesthesia fee and onsite physical therapy. 90-day bundles include all of this plus postoperative care for the first 90 days to include office visits, postoperative physical therapy and customized “navigation” as patients progress through their recovery.
Who is eligible for bundled payments?
Currently our practice offers bundled total hip and knee replacements for patients with several of the well-known insurance carriers. Surgery is performed as an outpatient at Stratham Ambulatory Surgery Center using our AVATAR customized rapid recovery care program. By avoiding hospital-based care, our bundled payment program can lead to cost savings of as much as 60% compared to traditional fee-for-service care despite no change in the care itself.
We also offer direct employer contracting and cash-pay options for self-insured companies, health sharing programs (such as ministries), or patients who simply wish to pay directly for healthcare without going through an insurance vehicle. Finally, we work with several companies who help align those seeking cash prices with those providing such services.