At-Risk Payer Models Helped The CORE Institute Sustain Through the Pandemic and Focus on Growth

Jason Scalise, MD, an orthopedic surgeon at Phoenix-based The CORE Institute and vice chairman of its management company HOPCo, outlines the practice’s main considerations as it prepares for elective surgeries to return. 

Question: What is your strategy for ramping surgery back up? 

Dr. Jason Scalise: Throughout this process, we have continued to care for patients’ urgent and acute musculoskeletal needs. Given the size of our organization, that continued to represent a considerable number of patients. We have adhered to local and national guidelines and postponed elective surgeries but have been in constant communication with patients who have been affected by this. We have prioritized patients based on most urgent needs as the restrictions begin to be eased. We have already planned for additional work hours at facilities such as our surgical specialty hospital to accommodate the surge in demand. 

Q: What is the biggest challenge for safety of patients and staff? 

JS: The safety of our patients and staff is our highest priority. As the restrictions in elective surgery are beginning to be lifted and the demand to address the backlog of care increases, a measured approach will be needed to ensure appropriate screening remains as we suspect it will continue to be recommended for the foreseeable future. We have implemented a robust screening infrastructure including antibody testing. By remaining true to our protocols and guidelines, I am confident we can mitigate any safety challenges that could otherwise occur. 

Q: What is your current backlog of surgical cases and how do you plan to recover financially? 

JS: Our backlog of postponed surgical cases is extensive. As we have been vigilant with our operations and finances throughout this process and have implemented extensive planning around potential challenges, we don’t really think of it as a financial ‘recovery’ per se. Instead, we feel we are well positioned to continue to move forward with patient care and practice growth opportunities. Due to our at-risk payer models, our savings-based revenues have increased. 

Q: What will your practice look like a year from now? 

JS: At the moment, it seems likely that several aspects or consequences of this pandemic will remain, at least in part. Social distancing, face masking and perhaps ongoing testing may continue to have a role a year from now. We also expect that most if not all of the telehealth opportunities will remain and perhaps even be encouraged going forward such that a new level of ‘virtual encounters’ may persist in the continuum of how we practice.

It also seems abundantly clear from all of the large payers around the country with whom we speak that as they also attempt to recover, a massive push towards alternative or at-risk payer models is eminent as a way of shifting even further the cost burden to providers and linking reimbursement to sustained performance. In order to perform well, physician practices should be prepared to quickly engage in robust data tracking and reporting capabilities, the ability demonstrate consistent clinical outcomes and be able to function in a population health type environment where a larger continuum of the patient’s care than just the surgical episode is the responsibility of the surgeon. Practices without the ability to do so quickly should look for partnerships that allow them to incorporate such resources.