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Continued: April 23: Doctors experiment with a single price, single bill for surgery

  • Article by: JACKIE CROSBY , Star Tribune
  • Last update: August 10, 2013 - 10:11 PM

Still, Twin Cities insurance companies have yet to embrace the one-price, one-bill offer. So far, only Medica has agreed to work with Twin Cities Orthopedics. Medica officials consider it a pilot and declined requests to talk about the program. HealthPartners is still considering it, Simonson said.

The hurdle? Bookkeeping. The arcane computerized billing system that girds the nation’s health care infrastructure is built around a fee-for-service model. That means there’s one code used to pay the surgeon, another to pay the person who reads X-rays, another to pay the pharmacist, and so on.

To get around this, Medica handles each claim for Twin Cities Orthopedics Excel program by hand. “Health care loves to overcomplicate things,” Simonson said.

Going around insurers

One approach that Twin Cities Orthopedics and other providers are using is to pitch their medical services directly to large businesses that insure their own workers.

Wal-Mart cut a bundled-care deal in October with six top hospitals, including the Mayo Clinic and Cleveland Clinic. The program covers certain cardiac and spine procedures as well as transplants at no additional cost for about 1.1 million employees and their families enrolled in the retailer’s health plan. Grocery chain Kroger Co. has flown employees around the country to get the best value for common orthopedic procedures.

Locally, Minnesota Gastroenterology, a physician-owned practice in St. Paul, offers a pay-one-price colonoscopy program that has a direct contract with Wilson Tool International.

When businesses foot the bill, Sorenson said, they have an incentive to keep costs down. He said a number of firms with 500 or more employees have shown an interest in the Twin Cities Orthopedics program, which Sorenson would like to expand to cover shoulder and hip replacement as well as conditions such as carpal tunnel syndrome and chronic back pain.

Chris Blegen, a 49-year-old firefighter whose workers’ comp insurer covered his new knee, said the one-on-one care took the stress out of the surgery. His wife, Cheryl, relaxing in a giant recliner chair last week at York Gardens, said she was grateful to avoid the beeping and constant disruptions of a hospital stay.

They could eat at the bistro downstairs or bring in groceries and cook in the efficiency kitchen.

Even the bus driver who brought the couple to York Gardens after the surgery knew to go slow over potholes to avoid jarring pain.

“You don’t feel like a number,” Blegen said. “You feel like you’re important to them.”

 

Jackie Crosby • 612-673-7335

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  • Physical therapist Brandon Schomberg supervised as Dr. Richard Golden worked out at Twin Cities Orthopedics in Edina. Golden got a right-knee replacement on Jan 15.

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