May 25, 2017

Medicare Bundled Payments Starting to Get Push-back?

Filed under: CMS,Incentive Payment Programs — HankMayers @ 4:00 pm

HealthAffairs Blog published, on May 9th, an article on the “fatal flaws” inherent in the Medicare bundled payment (BPCI) program. See:

Their concerns are as follows:

  • Their specified bundles are currently focused exclusively on in-patient care
  • Bundles lack factoring in consideration of patient severity
  • Encouraging hospitalizations for acute exacerbations of chronic conditions that could be otherwise adequately treated in non-inpatient settings
  • Quality measure reporting is just reporting – no performance thresholds on which to measure payment incentives
  • The quality targets are designed to move with trends, but the delays in notice can take up to 6 months so providers are not sure of the targets that their care will be judged against while care is actually delivered

One senses that there is a desire to have physicians be more in the driver seat on defining and controlling the encounters and the resulting quality. Indeed, HealthAffairs goes on to cite the recent recommendations of the Physician-Focused Payment Model Technical Advisory Committee (PTAC). Their recommendations apparently support an “episode of care model” developed by the American College of Physicians. Those recommendations include the following elements not currently in the BPCI

  1. Adjustments for patient severity
  2. Outcomes reflects gains and losses
  3. Physicians can self-assemble the best possible teams to manage a patient’s condition, illness, or injury
  4. Encouragement of teamwork across all involved physician disciplines
  5. Encourages physicians to find the most efficient and effective course of treatment and service setting for the patient

These are important factors that need to be properly incorporated into bundled payments. Of particular concern going forward, is that modifications need to be made, many along the above lines. However, the present administration in Washington has a penchant for declaring anything that preceded them as garbage. Hopefully, less polemically-oriented leaders will prevail, and an “improving/amending” approach will be adopted to make these changes.

We don’t need more confusion and discord in healthcare. We need continuing improvement.

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