ASC Total Joint Bundled Payment Program Achieving Triple Aim

“We’re leading the effort to keep costs down. The bundled payment sends a strong message to the payer: quality is very high, costs stay low and patients love it because the process is easy and seamless. They get one bill and we manage the care from surgery to physical therapy.”

Darci Nagorski, Administrator, St. Cloud Surgical Center

St. Cloud Surgical Center (SCSC), 90 minutes northwest of Minneapolis, is a pioneer in outpatient surgery. Today, in partnership with Surgical Care Affiliates (SCA), SCSC continues to innovate.

In 2015 SCSC started conducting outpatient total knee and total hip replacements using robotics. Since starting the program, SCSC has performed more than 1,150 total joint replacements with 95% patient satisfaction.

SCA Health developed a bundled payment with Blue Cross and Blue Shield of Minnesota to create a seamless continuum of care, from surgery to physical therapy—and all with just one bill. The single payment covers the surgeon’s fee, anesthesia and facility charges, post-surgical physical therapy, home health care, etc. “It’s one payment for the procedure and all the services a patient might need related to the surgery within 90 days,” says Marie Edler, MPH, Senior Vice President, Strategy and Payer Engagement at SCA Health.

According to Darci Nagorski, Administrator for the center, SCA Health manages the entire process, paying the anesthesiologist, physician and physical therapist, while ensuring that quality remains high. “We’re leading the effort to keep costs down. The bundled payment sends a strong message to the payer: quality is very high, costs stay low and patients love it because the process is easy and seamless,” says Stack.

Says Dr. Nessler: “The program is an excellent way to offer my patients and the insurers a cost effective solution to total joint replacement that appropriately shifts the financial incentives to us as care givers to make the optimal clinical decisions for our patients.”