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How bundled payments are changing the market

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The success of bundled payments hinges on a variety of factors — some ASC leaders are wary, while others have found success in value-based payments. 

Four healthcare leaders spoke with Becker's ASC Review on how value-based care is affecting their practices. 

John Lewis, CEO of Semmes Murphey, a brain and spine clinic in Memphis, Tenn., said his facility is offering "predictable, prospective" bundled payment arrangements to ensure the "highest-quality care while avoiding unnecessary tests and procedures." 

Mr. Lewis is also seeing more employers who want to work directly with providers to help control overall healthcare costs and the patient experience. 

Glen Silverman is the CEO of Mississippi Sports Medicine Clinic and Orthopaedic Center in Jackson. His facility performs upward of a 1,000 value-based care total joint and spine procedures annually. 

The real challenge with value-based payments, he said, is figuring out how to change the market.

"How do you create opportunity for alignment with insurers and self-insured brokers in the future, and how do you prove you can do it better while being more cost effective," he said. "The next step is to collect data on all cases, regardless of the venue and for all specialties."

These steps are necessary for practices to become market setters in value-based care, he said.

Taylor Burnett, the association president of the Mississippi Ambulatory Surgery Center Association, said that bundled payments are specifically successful in orthopedics and neurosurgery, particularly with the influx of private equity. 

"With such an increase in private-equity companies and big orthopedic neurosurgery groups, the payers have a direct line of communication in negotiating these," he said. "They seem to have greater success in those single-specialty ASCs."

Others are less optimistic about the future of bundled payments. 

James Zenman, PhD, the CEO of The Cardiac and Vascular Institute in Gainesville, Fla., told Becker's ASC Review that his facility is paying very close attention to the proposed bundled payment program for ASCs. 

"We participated in a bundled payment program with Medicare on a select group of surgeries, and the results were less than expected," he said. "The Medicare data was late, sometimes not accurate and not inclusive."

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