Tag Archives: bundled payment

Watch for potential pitfalls as CMS tests a new bundled payment program for cardiac care

Photo: Penn State via Flickr

The Centers for Medicare & Medicaid Services just announced a five-year test, to begin next summer, of a new way to pay for the care of patients who have had a heart attack or need coronary artery bypass graft surgery.

As with any new payment model, unintended consequences are possible. The experimental bundled-payment program, which was announced July 25 and will begin July 1, 2017, potential could lead some physicians to sell their practices to hospitals, be financially risky and potentially harmful to the hospitals forced to participate, and could lead to an increase in heart attacks, warned Francois de Brantes, executive director of the consulting firm Health Care Incentives Improvement Institute and an expert on bundled payment models. Continue reading

Knees and hips and what they could reveal about ACA’s quality drive

Photo: Oka Tai-Lee via Flickr

The Affordable Care Act created many opportunities for Medicare to test new ways of paying for health care. One of the biggest and most dramatic tests is now getting underway: bundled payments for hip or knee replacement.

Unlike most Center for Medicaid and Medicare Innovation (CMMI) projects on payment and delivery reform, this one is mandatory for hospitals in 67 geographic areas designated as participants. The test began April 1 and is supposed to run for five years. Continue reading

AHCJ webcast will address how payers, providers are implementing bundled payment

bundled-payment-webcastLate last month we wrote about criticism leveled at the federal government’s latest bundled payment proposal.

Since then, other experts have come forward to criticize not only the Comprehensive Care for Joint Replacement (CCJR) proposal announced last month, but also the Bundled Payments for Care Initiative (BPCI) program that began in April 2013. Both programs come from the federal Centers for Medicare & Medicaid Services.

You can find detailed criticism of CCJR from Harold Miller, president of the Center for Healthcare Quality and Payment Reform, on the CHQPR’s blog, and from Suzanne Delbanco, executive director of Catalyst for Payment Reform, and Francois de Brantes, executive director of the Health Care Incentives Improvement Institute (HCI3), on the Health Affairs blog. For an explanation of how CMS can improve the BPCI program, see this HCI3 blog post from de Brantes. Continue reading

Is CMS doing bundled payment for hip and knee replacement all wrong?

Earlier this month, the federal Centers for Medicare & Medicaid Services proposed a five-year bundled-payment test program for hip and knee replacement surgeries.

At the time, CMS said its Comprehensive Care for Joint Replacement (CCJR) program would require 800 hospitals in 75 areas to test bundled payments for most of the 100,000 hip and knee surgeries that Medicare covers annually.

The proposal, which we covered here, would allow CMS to eliminate some of the widespread variation in costs and offer one more way for the Obama administration to squeeze out fee-for-service reimbursement by transforming payment from volume to value, CMS said. Continue reading

Growing beyond the pilot stage, bundled payment gains wider acceptance

Health insurers are expanding the use of bundled payment as a core part of their efforts to reform how they deliver and pay for care, according to a new report commissioned by the Health Care Incentives Improvement Institute Inc. (HCI3), a nonprofit that supports bundled payment and other payment-reform initiatives. (See below for an announcement about an HCI3 webinar on bundled payment scheduled for June 24.)

The report (PDF) by consulting firm Bailit Health Purchasing LLC showed that bundled payment has grown beyond the pilot stage among Medicare, Medicaid and commercial insurers.

“While the number of providers and payers implementing bundled payments is relatively small, we observed growth in the adoption of bundled payment initiatives,” the report said. Last year, the federal Centers for Medicare & Medicaid Services approved more than 500 organizations to participate in its Bundled Payment for Care Improvement initiative. The Medicaid program in Arkansas has a bundled payment initiative, and Ohio and Tennessee are implementing similar programs. This level of activity may mean a movement toward broader adoption of bundled payment is on the horizon, the report said.

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