Last month, the Centers for Medicare and Medicaid Services launched an initiative to test a bundled payment system for services provided during acute episodes of care. Under the proposed system, CMS will link payments for multiple services patients receive during an inpatient stay and up to 90 days post discharge. Instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a "bundled" payment designed to incentivize a more efficient use of health care services, while maintaining or improving quality of care.
By Shari M. Erickson
Insofar as primary care physicians have a key role to play in providing post-discharge care that can help prevent readmission, the members of the American College of Physicians should tune in to how this testing project pans out.
The obvious good news is that CMS isn’t rolling out the new payment model without testing it first. CMS is giving all representative stakeholders – hospitals, physician-hospital organizations, health systems, postacute care providers, and large group practices – the opportunity to test drive one of four bundled payment models.
Of key concern is whether hospitals or other organizations that are put in charge of distributing reimbursement to primary care providers involved in postdischarge care will be fair. It’s hard to tell. A lot will depend on the degree to which primary care is able to obtain a seat at the table to negotiate its fair share of the pie. And that ultimately depends on the entities that choose to participate in this testing project.
Under the current payment system, primary care services have long been undervalued. The last thing we want is for a new system to disenfranchise them further. But despite that possible risk, we have to start somewhere. It’s time to move forward if we want to create a payment system that rewards patient-centered, high-quality, evidence-based care.
It is critical that the results of this testing phase be openly shared with providers and their professional organizations so that the bundled payment models can be modified as needed before they are implemented.
CMS is currently soliciting applications for this bundled payment initiative from physicians, hospitals, and other health care providers. The applicants that are accepted for participation in this program will gain insights and best practices about how to deliver efficient, effective, and high-quality care to patients while they are in the hospital and about how to avoid readmissions whenever possible. Our hope is that all providers will be given the opportunity to harness those lessons to put them to good use.
The chance to test a bundled payment system aimed at services provided to a chronically ill patient population is expected to be forthcoming from CMS. Potential applicants for that program should be on the lookout.
Ms. Erickson is director of regulatory and insurer affairs at the American College of Physicians. She reports having no conflicts of interest.