Orthopedic Reimbursement: What’s Your Competitive Advantage?

United offers employees cheaper hip, knee replacements if they travel to Chicago’s Rush

“Chicago-based United joins a group of large employers trying to be better buyers of health care. A lot of companies insure their own employees, rather than pay premiums to health insurers, so they have a big stake in keeping employees healthy and controlling spending on medical care and drugs.”  Click here for full article

With the wild variation in the cost of hip and knee replacements and the increasing volume of patients, it makes sense that traditional payers like the government and insurance companies are looking for more control over the prices. The Comprehensive Care for Joint Replacement (CJR) was the government’s first mandate of bundled payments, and every insurance company has bundle options for providers to participate. The United deal with Rush is just one in a new trend of companies cutting out the “middle-man” insurance company, and going directly to the health system to negotiate their own bundles.

To successfully attract and negotiate these deals, healthcare providers must be able to prove that they provide better value than the rest of their competitors. The often discussed “shift from volume to value” could also be viewed as medical reimbursement finally entering a market economy with a free price system where supply and demand will dictate price. Traditional business models have always worked in this space and understand they must provide a great product at an acceptable price, with quality control to keep their customers happy.

When the “product” is a hip or knee replacement, establishing product quality has traditionally been very ambiguous. Providers looking to thrive in this space should turn their focus to the Value Equation (Value=Patient Outcome/Cost). With the help of EHRs, Cost data has never been more accessible. Patient Outcomes are where Providers have the opportunity to prove they can provide better care with fewer complications – which is exactly what companies like United are looking for. This is a competitive advantage critical to any successful product or service in a free market.

What is your practice’s biggest competitive advantage?

Patient-reported outcomes (PROs) are the gold standard of outcomes. Unfortunately, most practices are still not collecting PROs. That means they are effectively eliminated from the competitive marketplace. Collecting PROs allows an organization to create and monitor value. It also allows you to benchmark against other competitive organizations. If you aren’t collecting PRO data you are falling behind.

Collecting PRO data does not have to be painful. CODE can make it simple.