Bundled payments ... ubiquitous change!

I'm a big believer that trends flow to their logical conclusion. If we look at the initiatives under way today in coordinated care, it should be no surprise that changes in the delivery model will flow to changes in the reimbursement model.


Look at this background statement for the Bundled Payments for Care Improvement initiative, from the CMS Innovation website:

Medicare currently makes separate payments to providers for the services they furnish to beneficiaries for a single illness or course of treatment, leading to fragmented care with minimal coordination across providers and health care settings. Payment is based on how much a provider does, not how well the provider does in treating the patient. 

Research has shown that bundled payments can align incentives for providers – hospitals, post acute care providers, doctors, and other practitioners– to partner closely across all specialties and settings that a patient may encounter to improve the patient’s experience of care during a hospital stay in an acute care hospital, and during post-discharge recovery.

As expected, most health care reform initiatives are contextualized in the hospital setting and flow from there into ambulatory care settings. It's important, therefore, that you, as an independent health care provider recognize Accountable Care Organizations (ACOs) as the bridge between these two worlds.

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.  

While the statement above comes from CMS, recognize that today there are more commercial ACOs than Medicare ACOs. It is a dangerous gamble to segregate CMS initiatives from those of other payers and pretend the trends don't matter because you don't see many Medicare or Medicaid patients.

In a similar vein, we still encounter the equally harmful gamble that "this is all going to go away" in the supposed defeat of Obamacare. Not so. While some aspects of payment reform (health insurance reform) will survive and others won't, health care reform is here to stay. It is not the object of the pending Supreme Court decision. For the well being of your business and private-practice profession, look back then look ahead. Ubiquitous change. Are you preparing for what it means to you? Are you participating alongside your colleagues to ensure that independent eye care providers have a place in the emerging models of health care, both delivery and reimbursement?

Alistair Jackson, M.Ed.