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Bundled Payments for Self-Pay Patients

As healthcare dramatically changes in the U.S., many patients with high insurance deductibles, captured insurance networks, or international patients now have the option to self-pay for quality orthopedic care.

Chicago sports medicine physician Nikhil Verma, MD of Midwest Orthopaedics at Rush and a team physician for the Chicago Bulls and White Sox is among first U.S. physicians associated with an academic health center to provide transparent healthcare bundled payments. As healthcare continues to dramatically change in the U.S., many patients with a captured insurance network, high insurance deductibles and international patients now have the option to self-pay. Dr. Nikhil Verma and the physicians at Midwest Orthopaedics at Rush continue to stay at the forefront of orthopedic care by providing quality care at an affordable price.

Today, the most common way to pay for healthcare services is a fee-for-service system, which involves a predetermined amount for each discrete service provided. In this system, it is often impossible for patients to know the total cost of a health care episode prior to the procedure being performed. The emphasis with fee-for- service is on volume of care rather than value of care. Healthcare bundled payments enable providers to reduce costs, improve value and increase accessibility. In addition, they allow patients to understand the total cost of their care prior to initiation of treatment.

High-deductible plans and captured insurance networks limit patients. Today, consumers are becoming more encouraged to shop around for healthcare services. A study by the nonprofit organization, Public Agenda, found that 56 percent of Americans have researched how much they would have to pay out of pocket or how much their insurer would pay before getting care. The study also found that 67 percent of patients with deductibles between $500 and $3,000, and 74 percent of patients with deductibles higher than $3,000 have tried to obtain price information before getting care.

“Part of the problem in the healthcare system is you can’t figure out the cost of the treatment process until a patient goes through it,” said Dr. Nikhil Verma. “We looked at five of our top outpatient arthroscopic procedures and came up with transparent prices for our patients,” he explained. “We published those prices so patients have easy access to what the cost may be if they need to pay out-of-pocket or for companies that are self-insured.”

Ranked as the #6 Hospital in the U.S. for Orthopedics and #1 in Illinois by U.S. News & World Report, Midwest Orthopaedics at Rush has established the below bundled prices for orthopedic surgery:

  • ACL (Autograft): $11,500
  • ACL (Allograft): $12,500
  • Knee Arthroscopy: $6,000
  • Rotator Cuff Repair: $12,500
  • Shoulder Arthroscopy: $11,000
  • Total Shoulder Replacement: $24,500
  • Total Shoulder Replacement – Reverse: $26,500

“These bundles are for patients who want a choice in healthcare and want to see one of our physicians based on quality and experience,” Dr. Verma said. “We get a lot of patients coming to us from other parts of the country or other parts of the world. This helps them understand the pricing. We look forward to expanding the program to include additional procedures, such as shoulder replacement in the near future. ”

For each package, the prices are non-negotiable and payment is expected in full when RUSH providers render the services. The patient pays Midwest Orthopaedics at Rush directly and third parties or insurance companies won’t be billed for services in the program.

The fixed bundled pricing plans include:

  • Surgeon fees – including initial consultation visit Facility fees
  • Anesthesia fees
  • Supplies and implants (if applicable) Uncomplicated follow-up care

Services patients may need to seek outside of the healthcare bundled payments include:

  • MRI or X-rays
  • Postoperative rehabilitation
  • Home health services
  • Physical therapy
  • Durable medical equipment
  • Postoperative medication

“Our impetus is to make the highest quality of healthcare affordable and transparent to the consumer,” said Dr. Verma. The bundled payment program will soon be expanding to include additional procedures and shoulder replacement. To learn more about the healthcare bundled payments offered for self-pay patients, please visit: RUSH Healthcare Bundled Payments.

About Dr. Nikhil Verma

Dr. Nikhil Verma is an orthopedic shoulder, elbow, knee and sports medicine specialist at Midwest Orthopaedics at Rush in Chicago, Illinois. Dr. Verma serves patients in Chicago, Westchester, Oak Brook, Hinsdale and other surrounding communities. Dr. Verma is a professor and director of sports medicine research for the Department of Orthopedic Surgery at Rush University Medical Center. Offering both surgical and nonsurgical treatment options for the shoulder, elbow and knee, Dr. Verma’s practice utilizes a unique treatment approach for every patient. His specialties include advanced arthroscopic reconstructive techniques of the shoulder, total shoulder replacement, elbow ligament reconstruction, cartilage reconstruction and arthroscopic knee ligament reconstruction.

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