- A new payment model is now available for BCBSNC customers who receive knee replacement surgeries at North Carolina Specialty Hospital.
- The new payment model secures a fixed rate that covers patients for the entire scope of knee replacement surgery, from 30 days before surgery through physical therapy and follow-up care for 90 days after surgery.
- The innovative agreement between TOA and BCBSNC aims to reduce potentially avoidable complications, lower costs and improve patient outcomes on total knee replacement surgeries.
CHAPEL HILL, N.C. – Blue Cross and Blue Shield of North Carolina (BCBSNC) and Triangle Orthopaedic Associates (TOA) are teaming up to bring a first-of-its-kind payment model to the Triangle. The agreement is also the first bundled payment model in North Carolina between BCBSNC and a physician-owned practice. The new payment model allows BCBSNC customers, including State Health Plan members, to pay a fixed price for knee replacement surgeries received at North Carolina Specialty Hospital. The hospital is physician-owned and holds a 5-star rating from Healthgrades for total knee replacements[i].
“We’ve found from a successful pilot program that this model is proven to reduce potentially avoidable complications, improve patient outcomes and reduce the cost of total knee replacement surgeries for our customers,” said Brad Wilson, BCBSNC president and CEO. “Innovative ideas like this bundled payment model are critical to making our health care system better, more effective and more focused on the needs of the patient. It is a win-win for BCBSNC, Triangle Orthopaedic Associates, patients and really the entire health care system.”
The bundled payment model is widely seen by the health care industry as an effective way to increase quality while reducing medical costs, particularly with joint replacement procedures, like knee surgeries. Under these agreements, medical teams will work together to reduce complications and prevent readmissions.
Rather than receive multiple bills from the surgeon, hospital, physical therapist and others, patients will make one payment to TOA when the knee replacement surgery is performed at North Carolina Specialty Hospital. The bundled payment model from BCBSNC and TOA includes:
- All pre-operative tests and office visits within 30 days of the scheduled procedure
- All appointments and care occurring during the inpatient stay, including the total knee replacement surgery, physical therapy and care related to any complications
- All related outpatient care for 90 days after surgery, including physical therapy and follow-up care received at TOA
“We are passionate about providing quality care for our patients. This new collaboration with BCBSNC is a great example of how all of us in the medical field need to begin approaching care,” said Thomas A. Dimmig, MD, President of Triangle Orthopaedic Associates. “We are excited to be a part of this initiative, which will provide value-based care that emphasizes the individual needs of every patient we see.”
**BCBSNC customers under FEP and Blue Medicare do not qualify for this payment model.
About Blue Cross and Blue Shield of North Carolina:
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.6 million members, including approximately 900,000 served on behalf of other Blue Plans. For 78 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at bcbsnc.com. ® Marks of the Blue Cross and Blue Shield Association. All other marks are the property of their respective owners.
About Triangle Orthopaedic Associates
Triangle Orthopaedic Associates (TOA), P.A. is the Triangle’s largest physician-directed medical practice, caring for patients through state-of-the-art medical treatment, orthopedic surgery, physical medicine and rehabilitation, rheumatology, general surgery, physical therapy, occupational (hand) therapy, and other medical and diagnostic services responsive to the needs of patients living within the counties it serves. TOA is responsive to the needs of patients living within the eight North Carolina counties it serves. For more information, visit http://www.triangleortho.com/.