美国华人麻醉医学会(Chinese American Society of Anesthesiology CASA) Newsletter, 2014(09)
Bundled Payment, What now?
Dr. Jeffrey Huang(黄建宏), M.D. Chair of CASA Practice Management. Tongji(同济) Medical University, China; Residency, Washington University School of Medicine, St Louis; Pain fellowship, Cleveland Clinic Foundation; practice in Orlando Health, Orlando, Florida
A bundled payment is a single payment that covers a set of services in specified healthcare settings, defined as an episode of care, within a certain time period. The Agency for Healthcare Research and Quality's (AHRQ) collection of evidence reports showed that bundled payment programs have been effective in cost containment without major effects on quality.
The Bundled Payments for Care Improvement initiative (BPCI) is comprised of four models of care. Jeffrey Huang ‐ Bundled Payment
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美国华人麻醉医学会(Chinese American Society of Anesthesiology CASA) Newsletter, 2014(09)
Model 1: Retrospective payment models for the acute inpatient hospital stay. Model 2: Retrospective bundled payment models for an episode of care consisting of an inpatient hospital stay followed by certain post-acute care. Model 3: Retrospective bundled payment models for post-acute care, without including the acute inpatient hospital stay. Model 4 is prospective payment for both the hospital and physicians (single payment), covering the acute inpatient stay and most readmissions within 30 days of discharge. On January 31, 2013, the Centers for Medicare & Medicaid Services (CMS) announced the health care organizations selected to participate in the Bundled Payments for Care Improvement initiative (BPCI).
450 healthcare organizations nationwide participated in the BPCI initiative. Now, the CMS has signed 243 providers to bundled-payment contracts. About 4,100 new applicants are eligible to join 2,400 hospitals, nursing homes and medical groups that are already candidates for Medicare's Bundled Payment for Care Improvement initiative.
It is obvious that bundled-payment programs will spread among both public and private payers. Some experts predicted movement of bundled payments within the entire healthcare industry within the next 12 to 18 months.
How to build successful bundled payment program? 1. Build a dedicated team: Clinical integration is necessary. Jeffrey Huang ‐ Bundled Payment
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美国华人麻醉医学会(Chinese American Society of Anesthesiology CASA) Newsletter, 2014(09)
All stakeholders must have common goal and vision. Physicians are positioned to take the leadership of a team. 2. Define the episode: CMS has defined and offered 4 models 3. Define the performance metrics: Surgical Care Improvement Project (SCIP) measures, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) scores, standard adverse event reporting measures, reoperation, readmission rates 4. Develop the care models: Incorporate best practices and, evidence based medicine. Develop standard care delivery protocol. Create checklist where each unique condition of the patient is considered 5. Audit the outcomes: Each element of the bundle payment program requires careful monitoring both for clinical outcomes and for financial considerations. 6. Develop continued improvement plan: Identify any cost saving opportunities. The distribution of cost savings between the surgeons, other physicians (anesthesiologists), and the hospital is an important element that needs to be negotiated prior to participating CMS the Bundled Payments for Care Improvement initiative (BPCI).
Jeffrey Huang ‐ Bundled Payment
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