Tips for Adapting to Bundled Payment Methodology
- Kaitlyn Bottner, CPA
- Dec 13, 2017
- 2 min read
Bundled payments remind me of the idea of eating healthy over the holidays…good and admirable in theory, but how do you actually achieve it? A recent HFMA podcast featuring Francois de Brantes, Vice President and Director for the Altarum Center for Payment Innovation, dove into the subject.
Below are a few interesting excerpts from the podcast:
• Bundled payments are about finding the “middle ground [as a provider] where, yes, you have responsibility around the financial and clinical outcomes of your patient but that responsibility is a responsibility that you can trace back to your actions.” • The key to success is to “create a scope around accountability that feels comfortable…for both providers and payers.” • So far, most bundled payments center on procedures but “the money is in chronic care management.” • Tips for negotiating risk-based contracts with payers:
o Negotiate a higher share of the upside since you are willing to accept some of the downside o Negotiate a stop loss for specific conditions, based on your expectations of the number of cases which will stay within the bundled payment amounts vs. those which will go over. This way, you will not lose all of your profits for good performance just because of a few outlier cases. o When you negotiate, think about “what’s my margin opportunity and what’s my potential downside.” This will tell you how many good cases you need to make up for downside cases.
You can listen to the full podcast here: https://soundcloud.com/hfma/joe-fifer-special-edition-podcast-sept-2017-edited
The future of bundled payments is certainly unclear. Less than one month ago, CMS cancelled two bundled payment models (Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model) and decreased the pool of providers required to participate in a third model (Comprehensive Care for Joint Replacement Model). CMS is also now allowing knee replacements in the outpatient setting.
However, whether or not bundled payments are scaled back, examining the entire episode of care can provide helpful insights to the providers and better care for the patient, even if there is no impact to reimbursement.