Blue Cross and Blue Shield of Rhode Island members getting knee or hip replacements at South County Hospital can now opt for a new bundled payment and coordinated care model that aims to improve health outcomes and control costs.
Under this “bundled payment model,” clinicians involved in the every step of the procedure – from primary care to surgery to physical therapy – coordinate a patient’s care and have incentives to use funds efficiently.
Dr. Robert Marchand, who performs total hip and knee replacements at South County Orthopedics explained that now, after a patient leaves the hospital, he or she might go to physical therapy for several months, when they really only need it for several weeks.
“It’s somewhat self-serving,” he said. “The more I see you, the more I get paid. But wouldn’t it be better if I get paid for your outcome?” he asked.
That’s the idea behind the bundled payment model. Blue Cross and South County are setting up protocols for the typical patient’s recovery to reduce overutilization of services, Marchand said. They are in the process of setting up relationships with home therapy providers and outpatient physical therapists to include them in this new “package of care” system.
South County Hospital and South County Orthopedics will aim to provide services from the first point of contact with a patient to 90 days after the surgery for a target amount of money paid by Blue Cross. They will share in the savings if the target is met or exceeded, Blue Cross Stacy Paterno spokesperson explained. If costs exceed the target, South County will be responsible for the additional costs.
Patients will also benefit, Marchand said. Patients who don’t need extensive physical therapy will no longer be “strung along” for several months, and fewer visits means fewer co-payments, he said.
South County Orthopedics performs 55 percent of total join replacements in the state and boasts the highest patient satisfaction ratings, Marchand said. They are able to keep costs down while maintaining good outcomes, and Marchand thinks that the bundled care model will help them further streamline their care and improve outcomes.
Patients just have to be willing to make the drive. “If I can get you a better result and not cost you a lot of money, I think you’d probably prefer that,” he said.
Blue Cross has plans to start bundle payment arrangements for total knee and hip replacements at other hospitals and provider groups around the state, in addition to expanding the model to other conditions and specialties, Paterno explained.
