CMS Bundled Payment Changes Untenable?

Karen Minich-Pourshadi, for HealthLeaders Media , December 10, 2012

"Applicants need to understand the risk that some of these changes can cause for their organization," she says.

Consider the example of a cardiac patient receiving treatment at Hospital A 80 miles from his or her home. Upon returning from the hospital, the patient fails to take medication. The patient starts having some mild pain and calls the primary care provider. The PCP knows the history of heart problems and immediately directs the patient to go to the nearest hospital—Hospital B. If this episode occurs within 30 days of the first admission, then Hospital A is responsible for the effects of any care given at Hospital B.

"Asking hospitals to take on risk for things like this where they have no control is going to be a non-starter for applicants," believes Baggot.

Baggot says a positive change to the CMS bundled payment program is the ability to preview the financial impact before signing an agreement to participate. CMS has agreed to collect six months of data for applicants, from January to June 2013. The data will help the applicants see their financial and readmission rates based on the new CMS guidelines, and allow the applicants to decide if this type of payment model is a viable option for their organizations.

That's a considerable plus for the many healthcare organizations that don't know where their patients go after they leave their building. Now hospitals will be able to see data on how different physicians would influence reimbursements.

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1 comments on "CMS Bundled Payment Changes Untenable?"

Maria K Todd,MHA Phd (12/10/2012 at 5:04 PM)
As a long time advocate and successful expert in bundled payment methodology, I can state with the courage of my conviction that the methodology for this bundled payment from CMS is fatally flawed. IF I were a provider, I would drop out if forced into this nightmare of politics and fantasy. I have published extensively on how to do it correctly, I've published case studies, and disasters. Bundled payment methodology is alive and well all over the world, and successful too. The problem here is the way the policy makers set up the system. It needs a complete overhaul to work. If I say more, it is going to sound like I am selling consulting from the pulpit, so I'll stop here. And no, hiring me won't "fix" what's broken. Maria K Todd, MHA PhD Author The Managed Care Contracting Handbook, 2nd ed., IPA, PHO, MSO Development Strategies The Physician Employment Contract Handbook, 2nd ed., and Physician Integration and Alignment: IPAs, PHOs, MSOs, ACOs and Beyond.




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