Muve Healthcare opened a joint replacement-focused ambulatory surgery center (ASC) in Lakeway outside of Austin in 2017. TOA recently conducted a Q&A with Marshall Maran of Muve to learn more about the concept.
TOA: Prior to your entrance into the Texas market, what has the ASC volume for lower extremity joint replacements been like in the state of Texas?
Marshall Maran: Total joint replacements in an ASC across the country are still in the very formative stages. Today, only 3 percent of the Medicare-certified ASCs list total joint replacements as a part of their service offerings. In Texas, the number of TJAs done in an ASC setting is also very low, but we expect that to increase in the months and years ahead.
TOA: How often do you all determine that a patient is not appropriate for your ASC setting?
MM: Our delivery model is a highly engineered, highly protocol driven care model. As a part of that, we do have a specific set of patient evaluation criteria we utilize to determine if a patient can be qualified to have their TJA performed in our facility. These criteria (such as BMI, A1C, active malignancies, tobacco use, etc.) are those typically employed by the nationally recognized joint centers in the country. However, the presence or the failure of a patient to meet our criteria doesn’t automatically exclude them as a joint replacement candidate at Muve. Rather, we’ll work with that patient to optimize their conditions to convert them into a qualified status. So if a patient’s BMI is above 40, we’ll work with them on a weight loss program or if they smoke tobacco, we’ll get them into a 30-day smoking cessation program. In the end, we’re not just “cherry picking” cases, but really working to use good clinical judgement and practices to optimize our patients for the best possible outcomes.
TOA: What separates Muve Healthcare from other joint replacement models?
MM: Muve is a hyperspecialized, full-episode program of care. It is not multi-specialty, and it is not “simply” an ASC, although an ASC is one of the elements that comprise the program. We enable an enhanced patient experience, greater physician control, and more optimized outcomes. Some of the specific factors that differentiate us from the traditional multispecialty ASC model:
TOA: How are you all approaching bundled payments in both commercial and Medicare markets?
MM: Muve’s business model is predicated on driving the utilization of value based reimbursement (VBR), and the model we’ve chosen to employ is a prospective bundled payment arrangement. Although we’ve been hearing a lot in the healthcare press about commercial-based bundles and VBR, this market talk has largely been aspirational rather than functional. As an example of how under-developed VBR is in Texas, we’re the only ASC we know of to have a 90-day prospective bundle for joint replacements for commercially insured beneficiaries. We believe the use of VBR models will expand over time and we’re poised to drive that expansion, but we hope more in the provider community will embrace this approach as it really creates a triple win in the market for patients, payers and surgeons.
As it relates to BPCI and BPCI-A, we’re not currently engaged with any of these models, as our focus is largely on the commercial segment coupled with the current limitations CMS has put on the provision of TJA procedures in freestanding ASCs. As CMS expands the delivery of TJA procedures to ASCs, we fully anticipate we’ll be serving the Medicare market place in the near future.
TOA: How are other physicians to the Muve Healthcare model?
MM: The orthopaedic surgeon community in Texas and markets throughout the U.S. is responding very favorably to Muve and our care delivery model. We often hear comments like “this is the future of healthcare” or “this is how I want to be providing care to my patients.” Back to the concept of design-based care delivery, when you create a model of healthcare that is purposefully built for it’s intended stakeholders, you can really create something special and achieve the Triple Aim objectives that have seemingly been so elusive for the industry.
TOA: What are the next plans for Muve Healthcare?
MM: We are expanding in Texas and have new facilities under development in four other states. Our focus will continue to be on lower extremity joint replacement, but we are also creating a program around certain spine procedures which we believe our model is well suited to provide. In the next three years, we plan to have 30 Muve facilities throughout the country and believe we’ll be one of the largest providers, by case volume, of joint replacement procedures in the U.S. by that point.