The Physician as the Provider at Risk: Rolling the Dice

Abstract

Background: There is significant need for physician innovation and leadership in health care as we adapt to bundled payment models of health care delivery.

Methods: We engaged a collective of 16 different private company orthopedic physician groups to apply to become episode initiators under BPCI models 2 and 3. The application process itself provided historical cost data, enabling each group to independently decide whether or not to proceed with the BPCI initiative.

Results: Ultimately, 7 of the private orthopedic groups decided to continue with the BPCI initiative. At the first quarter reconciliation, savings ranged from 9% to 17% across the participating groups.

Conclusion: The more leadership surgeons provide in value base care provision, the more our patients and health care system will benefit from optimization of care delivery.

Keywords: bundled payments for care improvement; comprehensive care for joint arthroplasty; gainsharing; managed care organization; physician group practice; value-based purchasing.