Tuesday, August 30th, 2011 - 7:53
Tuesday, August 30, 2011 - 07:37
The Centers for Medicare and Medicaid Services this month solicited proposals from health care providers for a new, more holistic way of providing care.
Earlier this month, the Centers for Medicare and Medicaid Services began soliciting proposals for bundled payments to treat patients, with specific deadlines for four different models.
The bundled payments are part of the Affordable Care Act, and many hope they will start to drive a revolution in health care delivery that will begin to "bend the cost curve," to borrow a phrase that many in the health care policy arena are so fond of. Instead of paying each individual doctor or provider for each individual service provided, no matter the outcome, the goal behind bundled payments is to pay a group of physicians and care providers a set amount of money for a specific outcome. This removes the much maligned incentive to provide as many tests or procedures as possible.
A similar effort is underway with Accountable Care Organizations. But the bundled payments method is available to a broader array of health providers that are too small to apply to be part of an ACO.
A helpful factsheet is available here from CMS. It presents the four different types of models, and the deadlines for proposals for each.
The four models are as follows:
1. Inpatient stay in a general acute care hospital.
2. Inpatient stay and post-acute care and would end at a minimum of 30 or 90 days after discharge.
3. Begin at discharge and end no sooner than 30 days after.
According to the CMS factsheet,
In the fourth model, CMS will make a prospectively determined bundled payment to a hospital for all services provided during inpatient stay.
The target price will be discounted from an amount based on the applicant’s historical fee-for-service payments for the episode. Payments will be made at the usual fee-for-service payment rates, after which the aggregate Medicare payment for the episode will be reconciled against the target price. Any reduction in expenditures beyond the discount reflected in the target price will be paid to the participants to share among the participating providers.
