By Karen Garloch
Hospital leaders in Charlotte talk a lot about transforming the health-care system and moving from “volume to value.”
By that, they mean a future where doctors and hospitals get paid, not just for treating patients each time they get sick, but for keeping them well.
Still, the current system relies mostly on so-called “fee-for-service” reimbursement, under which patients and insurance companies pay for each appointment, test or procedure. The more services, the more payments.
Instead of waiting for change to be imposed, doctors at Charlotte’s OrthoCarolina, one of the region’s largest physician groups, have taken the lead in adopting a system to simplify billing and improve coordination of care.
Patients undergoing knee and hip replacements can get a single bill with a “bundled payment” that covers preoperative care, surgery, followup appointments, 90 days of physical therapy and the services of a “patient navigator” who serves as a guide through the process.
“We get paid one price no matter how much work we do,” said Dr. Daniel Murrey, CEO of OrthoCarolina. “I’m projecting that by 2020, all of orthopedics will be paid this way. … It aligns everybody’s incentives to be focused on the right thing.”
OrthoCarolina, an orthopedics practice with 144 physicians in 33 locations, began working four years ago to build the system and recruit partners (hospitals, employers and insurance companies) for the bundled payment plan.
Since April, OrthoCarolina has contracted with Blue Cross and Blue Shield of North Carolina to provide joint replacement surgery for a single price for patients who agree to have their surgeries at Lake Norman Regional Medical Center in Mooresville. In early September, OrthoCarolina also began offering the plan for Blue Cross patients at Watauga Medical Center in Boone.