Health & Family

Novant Health, Blue Cross offer ‘bundled payment’ plan for knee replacement patients

Novant Health Presbyterian Medical Center is one of the sites where members of Blue Cross and Blue Shield of North Carolina can have knee replacement surgery under a “bundled payment” plan. That means they would get one bill for the entire procedure, including post-surgery care and physical therapy for up to 90 days.
Novant Health Presbyterian Medical Center is one of the sites where members of Blue Cross and Blue Shield of North Carolina can have knee replacement surgery under a “bundled payment” plan. That means they would get one bill for the entire procedure, including post-surgery care and physical therapy for up to 90 days. rlahser@charlotteobserver.com

Novant Health, in cooperation with Blue Cross and Blue Shield of North Carolina, is offering a single price for total knee replacement surgery.

The new arrangement “bundles” charges for multiple services – surgery, doctors’ visits and physical therapy – into one bill for patients. That’s a big change from the traditional system in which patients receive multiple bills from various health care providers.

Last year, about 1,000 Blue Cross customers benefited from similar bundled payment agreements. And on average, that saved 10 to 30 percent for knee replacement surgeries, improved outcomes, and reduced complications compared with other total knee replacements performed in the state, Blue Cross has said.

Novant Health providers participating in the agreement are Presbyterian Medical Center, Huntersville Medical Center, Drs. Bryan Edwards and Jess Kirby with Novant Health Orthopedics and Sports Medicine, and Dr. Howard Homesley with Barron and Homesley Orthopedics Specialists.

“With bundled payment agreements, like this one, patients pay one bill, even if they have to come back for another procedure or follow-up visit,” said Brad Wilson, Blue Cross CEO.

The bundled payment is only for Blue Cross members, including those in the State Health Plan. The single bill will cover services associated with knee replacement surgery, including follow-up appointments, physical therapy for up to 90 days after surgery, and “care coordination” from care managers who can answer questions and help navigate the health care system. Anesthesia charges will not be included in the bundled payments.

“These types of arrangements help patients understand their out-of-pocket expense for care by removing layers of complexity,” said Derek Goldin, Novant Health vice president in business development and sales.

Novant’s arrangement is similar to one OrthoCarolina has had with Blue Cross since April 2014. It is available to OrthoCarolina patients who agree to have joint replacement surgery at Lake Norman Regional Medical Center.

OrthoCarolina contracted with the Mooresville hospital because, until now, hospitals in Mecklenburg County have not participated in bundled payment plans. This is the first for Novant in the Charlotte area.

Blue Cross has said the bundled payments for joint replacements range from $22,000 to $30,000 in North Carolina. Traditional “unbundled” prices range from $27,500 to $47,300 across the state.

Garloch: 704-358-5078

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