North Carolina orthopedic ASC saves $15M using prospective bundle

The Surgical Center of Greensboro, an affiliate of Surgical Care Affiliates, released the outcomes of its first 1,000 commercial prospective 90-day bundles in early June, showing high quality and significant savings.

The outpatient joint program was started in September of 2017 and is run by Delta Joint Management, a collaborative effort of all orthopedic groups in Greensboro, N.C.. The collaborative has prospective commercial contracts with Blue Cross Blue Shield of North Carolina, UnitedHealthcare, Aetna, Cigna and Medcost.

As part of the collaborative, surgeons have performed 505 total knee replacements, 320 total hip replacements, 161 partial knee replacements and 14 total shoulder replacements. The reoperation rate was 1.1 percent; the readmission rate was 1.4 percent; the infection rate was 0.3 percent; the deep vein thrombosis rate was 0.2 percent; the manipulation rate was 4.4 percent. The patient satisfaction score was 99 percent.

Financially, the bundled payments created over $15 million in savings for the payers as well as a new revenue stream for the ASC and extra income to the surgeons based on a quality metric system.

"These results show that outpatient joint replacement is safe and effective. In fact, these results are superior to most inpatient results. In addition, since value is defined as outcomes divided by cost, these results verify that commercial prospective bundles can achieve both improved outcomes and decreased costs. So this program is creating tremendous value,” said Frank Aluisio, MD, president of Emerge Ortho and founding member of Delta.

The founding members and executive board of Delta Joint Management include Matt Olin, MD, of Emerge Ortho, Frank Rowan, MD, of Southeastern Orthopedic Specialists, and Steve Lucey, MD, of Wake Forest Baptist Health, in addition to Dr. Aluisio.

"The key to our success was creating standardized protocols and pathways and providing case management within our practices to provide concierge-level care for our patients. This is why our outcomes have been so good and our patient satisfaction so high," said Dr. Lucey, who serves as president of Delta.

The Surgery Center of Greensboro and Delta outpatient joint program runs on a software system called ValereCARE which includes a risk assessment tool, a case management platform, an outcomes measurement tool as well as serving as the financial tool to convene the bundle.

Delta is now accepting Medicare patients and will do over 500 joint operations at the ASC this year. It hopes to grow the program by adding simple revisions and Medicare total and reverse shoulders next year.


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