Southwest General Hospital Offering Fixed-Rate for Hip, Knee and Spine Surgeries

MIDDLEBURG HEIGHTS, OH - Optum, the health services division of UnitedHealth Group, has designated Southwest General’s Orthopedic Joint Center (OJC) as a Center of Excellence (COE). Southwest General is the only facility in northern Ohio to have been selected as a COE.

Optum’s COE network is part of its Spine and Joint Solution program, which helps large, self-insured employers manage the rapidly rising costs of care. Employers participating in the program pay a fixed “bundled payment” rate — negotiated between Southwest General and Optum — for the entire spectrum of a patient’s care, from initial diagnosis through recovery. Enrollees benefit from lower costs.

“We’re pleased that Optum has recognized our high-quality care, superior outcomes and lower costs for joint replacement procedures,” said William A. Young, Jr., president and chief executive officer, Southwest General. “Bundled payments provide cost predictability for employers and cost savings for patients, as care is often covered fully, with no out-of-pocket expenses. We look forward to caring for Optum enrollees to provide the excellent outcomes and cost-efficient care that all our orthopedic patients receive.”

Hospitals and surgery centers around the nation are moving towards a flat-fee payment scheme for patients. Most of those facilities say that they are doing so because of the complexity of healthcare offerings and the steep increase in out-of-pocket expenses for patients.

In May of this year, Midwest Orthopedics at Rush (MOR), whose physicians serve as the team doctors for the Chicago Bulls and the Chicago White Sox, began offering five surgical procedures for patients at a flat-fee rate. MOR's pricing was:

• Anterior Cruciate Ligament (ACL) Repair, $10,800
• Hip Arthroscopy, $13,250
• Knee Arthroscopy, $5,000
• Rotator Cuff Repair (Arthroscopic), $11,300
• Shoulder Arthroscopy, $10,000

The Surgery Center of Oklahoma transitioned to a similar model in 2009, as well.

Optum’s COE program is available to patients with UnitedHealth coverage from an employer-sponsored plan that includes this benefit. Based on the excellent quality of care and lower costs of care, the COE program is expected to become the program of choice by even more employers in 2017.

“For many of these eligible patients, they would have zero out-of-pocket costs associated with their surgery or post-op care,” says Young. “In today’s health care environment, this is a rather large incentive for patients when choosing a program that is not only based on quality but also high patient satisfaction, such as the one at Southwest General.”

Image from Southwest General