Telemedicine Adds Value to an Orthopedic Bundled Payment Plan

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For orthopedic practices looking to improve post-acute care, a bundled payment plan that incorporates telemedicine can reduce expenses and improve patient outcomes. But it takes careful planning to create a good bundle.

“You’ve got to know the business,” says Stephen Lucey, MD, an orthopedic surgeon with Greensboro, N.C.-based Delta Joint Management. “Telehealth offers tons of opportunity for improving care, but you need to know how to fit it in.”

Delta Joint Management, a network of three Greensboro-based orthopedic clinics, has negotiated physician-controlled bundled payment plans with health plans for its joint replacement patients. The group uses VERA (Virtual Exercise Rehabilitation Assistant), a connected health platform developed by San Diego-based Reflexion Health, to guide patients in home-based rehabilitation programs following surgery.

Lucey sees physician-controlled bundled payment plans as the wave of the future for post-acute care, and he expects that telehealth and telemedicine will become further integrated into these plans as physicians become more comfortable with the technology – and as the payer market evaluates the savings and outcomes compared to traditional in-person care.

“First of all, the physician should be in charge because we’re the ones who care for the patient,” he says. “And with telemedicine, I’m actively managing my patients (outside the doctor’s office). I’m regaining that control over their care, and I feel real comfortable when I know what they’re doing.”

READ MORE: Telehealth Gives Trainers, Physical Therapists a Healthcare Niche

With a bundled payment plan, providers, payers and outpatient services (such as rehab centers) come together to work out a course of treatment and a dollar amount for that plan. In a physician-controlled plan, the payer pays the physician that amount, and it’s then up to the physician to make that plan work.

Using telehealth, Lucey says he can create a post-acute care plan that enables patients to recover at home and at their own pace, while he monitors their activity on the connected care platform, adjusts the treatment as needed and measures outcomes.

Joe Smith, Reflexion Health’s president and Chief Executive Officer, says physicians and payers “have to have frank discussions” about how to create a bundled payment plan. If a physician can come to the table with data that show improved outcomes at a lower cost, the payer will be more receptive to crafting a physician-controlled plan. And telehealth enables that physician to connect and collaborate more freely with the patient outside the doctor’s office and gather daily, weekly or monthly data that proves clinical progress.

“This is a tool in the toolkit for value-based orthopedics,” he says.

In laying out a bundled plan, Lucey and Smith both say it’s important for the provider to map out all of the participants in a care program and assign value for the care they provide.

READ MORE: CMS Reimbursing For Telemedicine Even As It Scales Back Programs

“You’re bundling all the stuff that’s going to happen and giving it a number,” says Smith. “You have to be thorough. This incentivizes the provider to manage the care continuum.”

“You have to check every line item in the bundle to make sure it has value,” adds Lucey. “Anyone involved in that patient’s care should be paid for the value of that care.”

Likewise, Lucey cautions that providers need to keep an eye out for “sharks in the water,” or services that add to the bottom line but don’t deliver the results needed to justify the cost. If a bundled payment plan includes too many services, it might become too expensive for a payer to support, while services in a plan that fail to produce outcomes end up reducing the plan’s value – and taking money away from other providers.

Smith says payers often look at bundled payment plans as replicating the traditional, face-to-face model of care. In fact, a bundled plan that incorporates telehealth has the ability to go beyond the traditional model and introduce new services, including preventive health.

“There’s greater value in augmenting traditional services with health and wellness,” he says, giving an example of a fall prevention program that might help joint replacement patients improve mobility and reduce chances of hospitalization down the road. “Then you start to think about all the kinds of services you can put into a program that improve a patient’s lifestyle.”

READ MORE: Providers Must Negotiate Telehealth Reimbursement With Payers

“Some payers look for that,” Smith adds. “They see rehospitalizations – that gains their attention more than the integrated dollar amount.”

Finally, both Lucey and Smith say a provider should design a bundled payment plan with enough flexibility to be both standardized and scalable. A telehealth platform that enables physicians to personalize care plans for each patient fits that bill, as does one that can accommodate larger populations.

“It’s not just about the technology,” says Lucey. “It’s about the care plan. If you can make it work for the patient, you’re going to be successful.”