Play­ing well to­gether

Bun­dled pay­ments an­swer call for in­cen­tives to bet­ter co­or­di­nate care

Modern Healthcare - - OPINIONS COMMENTARY - Valinda Rut­ledge and Dr. Nancy Nielsen

Last month, the CMS an­nounced the Bun­dled Pay­ment for Care Im­prove­ment ini­tia­tive, a unique op­por­tu­nity made pos­si­ble by the Pa­tient Pro­tec­tion and Af­ford­able Care Act for physi­cians, hos­pi­tals, post-acute providers and oth­ers to come to­gether as part­ners, to re­design Medi­care pay­ments and sig­nif­i­cantly im­prove co­or­di­na­tion of care.

We come to the Cen­ter for Medi­care and Med­i­caid In­no­va­tion Cen­ter as a former hos­pi­tal CEO and a prac­tic­ing physi­cian who has served as pres­i­dent of the Amer­i­can Med­i­cal As­so­ci­a­tion. We see enor­mous prom­ise in this ini­tia­tive, not least be­cause bundling pay­ments based on episodes of care makes sense.

Pa­tients ex­pe­ri­ence care based on an episode of ill­ness or in­jury; why can’t providers de­liver and be paid the same way? In ad­di­tion, bet­ter co­or­di­na­tion of care can raise qual­ity, by re­duc­ing un­nec­es­sary du­pli­ca­tion of ser­vices and pre­ventable med­i­cal er­rors, help­ing pa­tients heal with­out harm. And all of these can lower costs both for the ben­e­fi­ciary and the Medi­care pro­gram.

For years, physi­cians have asked that the bar­rier be­tween Medi­care Part A (hos­pi­tal and other in­sti­tu­tional ser­vices) and Medi­care Part B (physi­cian and other out­pa­tient ser­vices) be elim­i­nated, so pay­ments could be bet­ter aligned with care im­prove­ment ef­forts. The bun­dled pay­ments ini­tia­tive re­sponds to this call.

This demon­stra­tion pro­gram gives hos­pi­tals and physi­cians a greater in­cen­tive to co­or­di­nate care dur­ing an in­pa­tient stay and en­sure con­ti­nu­ity of care as the pa­tient con­tin­ues to heal af­ter dis­charge. So, rather than pay­ing for ser­vices sep­a­rately, the ini­tia­tive will align pay­ments across an episode of care that be­gins with an in­pa­tient stay.

The in­no­va­tion cen­ter will re­quire par­tic­i­pants to en­sure that qual­ity and ex­pe­ri­ence of care im­prove and costs fall while pro­tect­ing the pa­tient’s rights to de­cide how they re­ceive their care.

The in­no­va­tion cen­ter will of­fer learn­ing ses­sions and other sup­port to help par­tic­i­pants col­lab­o­rate and share best prac­tices. But it will be the physi­cians and hos­pi­tals that pro­pose the con­di­tions and re­lated ser­vices to tar­get, the episode’s time frame and other de­tails.

The bun­dled pay­ments ini­tia­tive will test four mod­els. One cov­ers in­pa­tient hos­pi­tal will be per­mit­ted to pay in­cen­tives to physi­cians to find ways to im­prove care and save money.

We know it seems like a para­dox that hos­pi­tals (and physi­cians) could ben­e­fit fi­nan­cially by charg­ing Medi­care less for their ser­vices. How­ever, the CMS knows of a num­ber of hos­pi­tals that with rel­a­tively modest re­sources and ef­fort have im­proved qual­ity of care and sig­nif­i­cantly low­ered cost. These hos­pi­tals have fo­cused me­thod­i­cally on par­tic­u­lar di­ag­nos­tic groups, and then adapted the care im­prove­ment and cost-sav­ing strate­gies iden­ti­fied to other di­ag­nos­tic groups, and to the care fur­nished to pa­tients cov­ered by com­mer­cial in­sur­ance.

Doc­tors, hos­pi­tals and other health­care providers can ap­ply now to par­tic­i­pate in the bun­dled pay­ments ini­tia­tive. For mod­els other than the in­pa­tient-only model, the in­no­va­tion cen­ter will pro­vide Medi­care data to ap­pli­cants to help them re­fine their pro­pos­als.

Over the past year, the in­no­va­tion cen­ter has vis­ited clin­ics and hos­pi­tals across the coun­try to dis­cuss how care can be im­proved and costs re­duced. In ad­di­tion, the in­no­va­tion cen­ter has re­ceived hundreds of ideas for im­prov­ing care de­liv­ery through the “Share Your Ideas” page on its web­site, in­no­va­ There’s a per­va­sive theme run­ning through this feed­back—by work­ing to­gether, doc­tors and hos­pi­tals can find ways to de­liver the high­est qual­ity care and lower costs at the same time. The CMS shares this premise and, through its in­no­va­tion cen­ter, can help.

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