Surgery and Bundled Payment Models
Read the Bariatric Surgical Bundle
Read the Bariatric Surgical Warranty
(Adopted November 2016)
Read our Summary
Supporting Materials
- Letter from Health Care Authority Accepting Bariatric Surgical Bundle and Warranty
- Evidence Table for Bariatric Surgical Bundle
- Accountable Payment Models: Bariatric Surgery Charter
Workgroup Members
| Member | Title | Organization |
| Sharon Eloranta, MD | Medical Director, Quality and Safety Initiatives | Qualis Health |
| Kristin Helton, PhD | Consumer | |
| Jeff Hooper, MD | Medical Director, Weight Loss Program | MultiCare Health System |
| Dan Kent, MD | Chief Medical Officer | United Health Care |
| Saurabh Khandelwal, MD | Bariatric Surgeon | University of Washington |
| Robert Mecklenburg, MD (Co-Chair) | Medical Director, Center for Health Care Solutions | Virginia Mason Medical Center |
| Robert Michaelson, MD, PhD, FACS, FASMBS | President | Washington State Chapter, American Society for Metabolic and Bariatric Surgery |
| Thien Nguyen, MD | Bariatric Program Medical Director | Overlake Medical Center |
| Tom Richards | Consumer | |
| Kerry Schaefer (Co-Chair) | Strategic Planner for Employee Health | King County |
| Jonathan Stoehr, MD/Jeff Hunter, MD | Endocrinologist/ Bariatric Surgeon | Virginia Mason Medical Center |
| Brian Sung, MD | Bariatric Surgery Director | Swedish Medical Center |
| Tina Turner | Senior Internal Consultant | Premera Blue Cross |
| Richard Thirlby, MD | Medical Director | Surgical Care and Outcomes Assessment Program (SCOAP) |
Read the Coronary Artery Bypass Graft Surgical Bundle
Read the Coronary Artery Bypass Graft Surgical Warranty
(Adopted September 2015)
Read our Summary
The majority of health care payments are for number of services provided rather than quality of care or per person or per unit of time. This workgroup develops recommendations to tie provider payment to an entire episode of care including potential complications resulting from poor care and has focused on total knee and total hip replacement, lumbar fusion, and coronary artery bypass surgery. The coronary artery bypass graft surgery workgroup met from February 2015 – September 2015.
Supporting Materials
- Letter from Health Care Authority Accepting Coronary Artery Bypass Graft Surgical Bundle and Warranty
- CABG Bundle Public Comment
- Coronary Artery Bypass Graft Surgery Evidence Table
- CABG Bundle Public Comment
Workgroup Members
| Member | Title | Organization |
|---|---|---|
| Drew Baldwin, MD, FACC | Cardiologist | Virginia Mason Medical Center |
| Glenn Barnhart, MD | Cardiac Surgeon | Swedish Medical Center |
| Marissa Brooks | Director of Health Improvement Programs | SEUI Healthcare Northwest Benefits |
| Susie Dade, MS | Deputy Director | Washington Health Alliance |
| Gregory Eberhart, MD, FACC | Medical Director, Cardiology | CHI Franciscan Health |
| Theresa Helle | Manager of Health Care Quality and Efficiency Initiatives | The Boeing Company |
| Bob Herr, MD | Physician | US HealthWorks |
| Jeff Hummel, MD | Medical Director, Health Care Informatics | Qualis Health |
| Dan Kent, MD | Medical Director, Quality & Medical Management | Premera Blue Cross |
| Robert Mecklenburg, MD (Co-Chair) | Medical Director, Center for Health Care Solutions | Virginia Mason Medical Center |
| Vinay Malhotra, MD | Cardiologist | Cardiac Study Center |
| Kerry Schaefer, MS (Co-Chair) | Strategic Planner for Employee Health | King County |
| Gregg Shibata | Manager, Accountable Health Implementation | Regence Blue Shield |
| Shilpen Patel, MD, FACRO | Medical Director | Clinical Outcomes Assessment Program |
| Thomas Richards | Managing Director, Employee Benefits | Alaska Airlines |
Read our Cardiology Report and Recommendations
(Adopted January 2013)
Percutaneous coronary intervention (PCI), also known as angioplasty, is a non-surgical procedure used to treat excess plaque in the arteries. While the majority of these procedures are done appropriately and successfully as needed for emergency cardiovascular conditions, a significant number are done electively and may not benefit patients in the same way. One way to improve care given to patients is to look at the data on whether past PCI procedures were appropriate. The availability and transparency of this data is a major issue across Washington State hospitals.
To increase data visibility, improve appropriate PCI use, and decrease variation, we recommend building on the efforts of the Clinical Outcomes Assessment Program (COAP), a neutral, third-party quality improvement program of the Foundation for Health Care Quality. All hospitals in Washington State who perform open-heart surgery and PCIs participate in COAP. We recommend that COAP publicly disclose hospitals’ insufficient information reports and the appropriateness of PCI procedures. COAP staff are continuing to monitor rates of insufficient information and PCI appropriateness to assess the impact of public disclosure.
Supporting Materials
- Appropriate Use of PCI, 2012, by hospital
- Letter from Health Care Authority Accepting Spine SCOAP and Cardiology Recommendations
- Article on Appropriateness of PCIs, Journal of the American Medical Association, June 2011: Appropriateness of Percutaneous Coronary Interventions in Washington State; S. Bradley, C. Maynard, C. Bryson; Circulation – Cardiovascular Quality and Outcomes – Journal of the American Heart Association; May 8, 2012
Read our Guidelines
(Adopted January 2018)
Hysterectomy is one of the most commonly performed procedures in the United States, but rates are highly variable based on location. The workgroup met from March 2017 to January 2018 to develop to promote appropriate use of hysterectomy, including pre-surgical counseling and evaluation, while recognizing individual variation based on clinical opinion and patient preference with the following focus areas:
- Assessment and medical management, by indication
- Uterine sparing procedures, by indication
- Surgical procedure including follow-up care, emphasizing the enhanced recovery after surgery protocol and use of a minimally invasive approach
Supporting Materials
- Letter from the Health Care Authority Accepting Hysterectomy Recommendations
- Hysterectomy Charter and Roster
Workgroup Members
| Name | Title | Organization |
| Pat Kulpa, MD, MBA | Medical Director | Regence BlueShield |
| Sharon Kwan, MD, MS | Interventional Radiologist | University of Washington Medical Center |
| John Lenihan, MD | Medical Director of Robotics and Minimally Invasive Surgery | MultiCare Health System |
| Jennie Mao, MD | Clinical Assistant Professor, Department of Obstetrics and Gynecology | University of Washington Medical Center |
| Rachelle McCarty, MPH | Patient Advocate | |
| Sarah Prager, MD | Chair | Washington State Section of ACOG |
| Kevin Pieper, MD | Chief, Women’s and Children’s | Providence Regional Medical Center Everett |
| Kristin Riley, MD, FACOG | Assistant Professor, Department of Obstetrics and Gynecology | University of Washington Medical Center |
| Jeanne Rupert, DO, PhD (Chair) | Family Physician | One Medical |
| Anita Showalter, DO, FACOOG | Associate Professor and Chair, Women’s Health | Pacific Northwest University of Health Sciences |
| Susan Warwick, MD | Obstetrics and Gynecology | Kaiser Permanente |
Read the Lumbar Fusion Bundle and Warranty
(Adopted January 2019)
Read our Summary
The majority of health care payments are for number of services provided rather than quality of care or per person or per unit of time. This workgroup develops recommendations to tie provider payment to an entire episode of care including potential complications resulting from poor care and has focused on total knee and total hip replacement, lumbar fusion, and coronary artery bypass surgery.
Previous Meeting Materials
Re-Review Workgroup Members
| Member | Title | Organization |
|---|---|---|
| Robert Mecklenburg, MD (Co-Chair) | Medical Director, Center for Health Care Solutions | Virginia Mason Medical Center |
| Kerry Schaefer, MS (Co-Chair) | Strategic Planner for Employee Health | King County |
| Lydia Bartholomew, MD | Senior Medical Director, Pacific Northwest | Aetna |
| Arman Dagal, MD | Medical Director | Spine SCOAP |
| Sharon Eloranta, MD | Division Director, Clinical Excellence and Quality | CHI Franciscan Health |
| Farrokh Farrokhi, MD | Neurosurgeon | Virginia Mason Medical Center |
| Gary Franklin MD, MPH | Medical Director | Washington State Department of Labor and Industries |
| Andrew Friedman, MD | Physical Medicine and Rehabilitation | Virginia Mason Medical Center |
| Michael Hatzakis, MD | Physiatrist | Overlake Medical Center |
| Sara Groves-Rupp | Asst Administrator, Performance Improvement | University of Washington Medicine |
| Marcia Peterson | Manager of Benefits Strategy and Design | Washington State Health Care Authority |
| Linda Radach | Patient Advocate | |
| Mia Wise, DO | Medical Director, Provider & Customer Engagement | Premera Blue Cross |
| Jason Thompson, MD | Spine Surgeon | Proliance Surgeons |
Workgroup Members
| Member | Title | Organization |
|---|---|---|
| Susie Dade. MS | Deputy Director | Washington Health Alliance |
| Gary Franklin. MD, MPH | Medical Director | Washington State Department of Labor and Industries |
| April Gibson | Administrator | Puget Sound Orthopaedics |
| Dan Kent. MD | Medical Director, Quality & Medical Management | Premera Blue Cross |
| Bob Manley. MD | Surgeon | Regence Blue Shield |
| Gary McLaughlin | Vice President of Finance, Chief Financial Officer | Overlake Hospital |
| Robert Mecklenburg. MD (Chair) | Medical Director, Center for Health Care Solutions | Virginia Mason Medical Center |
| Peter Nora. MD | Chief of Neurological Surgery | Swedish Medical Center |
| Charissa Raynor | Executive Director | SEIU Healthcare NW Benefits |
| Kerry Schaefer, MS | Strategic Planner for Employee Health | King County |
| Julie Sylvester | Vice President of Quality and Safety Initiatives | Qualis Health |
| Jay Tihinen | Assistant Vice President Benefits | Costco |
This topic was re-reviewed in 2021
Read the Total Knee and Total Hip Replacement Bundle and Warranty
(Adopted November 2021)
Read our Summary on Bundled Payments from 2017
This workgroup first chose to focus on knee and hip replacements due to the high volume of these procedures and the high variability in how the procedures are performed. To see this high variation, read the readmissions rates by hospital for Washington State:
Total Knee and Total Hip Replacement Readmission Rates Washington State – Overall and By Hospital
(Adopted October 2013)
The total knee and total hip replacement workgroup met from November 2012 to October 2013. The lumbar fusion workgroup met from January 2014 to August 2014. The coronary artery bypass graft surgery workgroup met from February 2015 – September 2015. The bariatric surgical workgroup met from February to November 2016. The re-review of the total knee and total hip replacement workgroup met from December 2016 to November 2017.The workgroup to re-review the lumbar fusion bundle and warranty met from January 2018 to January 2019. An additional re-review of the total knee and total hip replacement workgroup met from January 2021 – November 2021.
2021 Re-Review Workgroup Members
| Member | Title | Organization |
| Robert Mecklenburg, MD | Emeritus | Virginia Mason Medical Center |
| Matt Albright Kevin Flemming, MBA Michael Griffin |
Regional Director of Orthopedics and Sports Medicine Chief Operating Officer Associate Vice President |
Providence St. Joseph’s Hospital |
| Linda Bartholomew, MD, MHA, FAAPL, FAAFP, CHIE | CMO Clinical Health Services, West and Southcentral | Aetna |
| LuAnn Chen, MD, MHA | Senior Medical Director | Community Health Plan of Washington |
| Michael CHen | Senior Program Consultant | Premera Blue Cross |
| Andrew Friedman, MD Kevin Macdonald, MD |
Physical Medicine & Rehabilitation Specialist Orthopedic Surgeon |
Virginia Mason Medical Center |
| Paul Manner, MD | Orthopedic Surgeon | University of Washington |
| Cat Mazzawy, RN | Senior Director, Safety and Quality | Washington State Hospital Association |
| Steven Overman, MD, MPH | KenSci | Tegria | |
| Linda Radach | Patient Advocate | |
| Tom Stoll, MD | Chief, Orthopedic Surgery | Kaiser Permanente Washington |
| Emily Transue, MD, MHA | Associate Medical Director | Health Care Authority |
2017 Re-Review Workgroup Members
| Member | Title | Organization |
| Lydia Bartholomew, MD | Senior Medical Director, Pacific Northwest | Aetna |
| Shawn Boice, RN, BSN, MHA | Nurse Navigator, MSK Administration | Evergreen Health Care |
| Greg Brown, MD, PhD | Orthopedic Surgeon | CHI Franciscan |
| Sharon Eloranta, MD | Medical Director, Quality and Safety Initiatives | Qualis Health |
| Andrew Friedman, MD | Physiatrist | Virginia Mason Medical Center |
| Fred Huang, MD | Orthopedic Surgeon | Proliance Orthopedic Associates |
| Kevin Macdonald, MD | Orthopedic Oncology, Adult Reconstruction | Virginia Mason Medical Center |
| Robert Mecklenburg, MD (Co-Chair) | Medical Director, Center for Health Care Solutions | Virginia Mason Medical Center |
| Linda Radach | Patient Advocate | |
| Kerry Schaefer, MS (Co-Chair) | Strategic Planner for Employee Health | King County |
| Jacqui Sinatra, MPA, FACHE | Service Line Director of Sports, Spine, & Ortho Health Svc | University of Washington Medical Center |
| Gaelon Spradley | Chief of Clinic Operations | Mason General Hospital |
| Theresa Sullivan | CEO | Samaritan Healthcare, Moses Lake |
.2013 Workgroup Members
| Member | Title | Organization |
|---|---|---|
| Susie Dade, MS | Deputy Director | Washington Health Alliance |
| Joe Gifford, MD | Chief Strategy and Innovation Officer for Western Washington | Providence Health and Services |
| Bob Herr, MD | Medical Director, Government Programs | Regence Blue Shield |
| Tom Hutchinson | Practice Administrator | PeaceHealth |
| Rich Maturi | Senior Vice President, Health Care Delivery Systems | Premera Blue Cross |
| Gary McLaughlin | Vice President of Finance | Overlake Hospital |
| Robert Mecklenburg, MD (Chair) | Medical Director, Center for Health Care Solutions | Virginia Mason Medical Center |
| Kerry Schaefer, MS | Strategic Planner For Employee Health | King County |
| Julie Sylvester |
© 2024 Foundation for Health Care Quality | Privacy Statement | Disclaimer