CMS wants you and your peers to sign up for its new bundled payment initiative aimed at streamlining patient care during and after inpatient hospital stays while reducing Medicare costs, HHS Secretary Kathleen Sebelius announced in a conference call Aug. 23.
The Bundled Payments for Care Improvement pilot program, set to launch in 2012, is the attempt to save money prompted by the health care reform law. It encourages providers to administer quality care by voluntarily participating in one of four bundled payment models. A main goal for the initiative is to establish clear communication between hospitals and practice physicians regarding discharged patients through the bundling. Similar to accountable care organization (ACO), physicians can share cost-saving gains with the bundling initiative but will be penalized if efforts to temper costs fail.
“Bundled payments are not new, and can be complex to implement and maintain,” says Miranda Franco, government affairs representative with the Medical Group Management Association (MGMA), which has just begun its analysis of the very new program’s impact on providers. The MGMA hopes that CMS will require extensive consensus building between hospitals and providers as they test various models of bundled payment, she says.
Each participant will have a three-year trial with the option for a fourth. The first three models follow a retrospective payment system in which CMS sets a target price for a “defined episode of care,” such as all surgeries, follow-up treatments, and necessary care for a heart attack patient, according to the CMS-released fact sheet on the program. This target price is lower than the traditional Medicare fee-for-service rates and providers exceeding the target will be penalized and have to pay the difference out-of-pocket. However, providers pocket the difference if they meet or beat the target price.
The fourth model follows a prospective payment bundling plan where providers will be paid a lump sum at the start of care for inpatient stays. Two of the models target hospitals and acute care facilities while the remaining two are for post-discharge services, likely candidates for high individual practice participation.Providers can decide the services and types of conditions, such as cardiac care, that they would like the payments bundled.
Interested providers must submit applications to CMS before Sept. 22 or Nov. 4, depending on the payment model. You can submit comments on the rule until Sept. 22 electronically at www.regulations.gov or you can email them to bundledpayments@cms.hhs.gov.