Beyond EHRs - Phase 5

Today's post focuses on the last of a 5-phase continuum. If you're joining the discussion today for the first time, please refer back to our July 20th post for the big-picture overview.

At last, the end game: phase 5, Get paid through a bundled payment system. From the early days of health care reform we knew that fee-for-service reimbursement would yield to pay-for-performance. At that time, the bundled payment angle was not evident. We suspect that it's still not generally understood. Let us say it clearly and unmistakably: the way you are being paid now for your services is being phased out. 

The change will not be abrupt or sweeping but slowly you will stop billing payers directly. Instead, you will be reimbursed by the Medical Home groups (teams) with which you work. Why? Because the groups who are paid to coordinate all care for their patients will also receive bundled payments for those services and will be required to distribute funds to the participating providers based on their contribution to the care of the patient.

Surprised? Shocked perhaps? This payment model raises concerns and questions, to be sure. However, a greater question than any about being inside that reimbursement model is the question about being outside it. It is this very issue that brought us to state years ago already that "health care reform is not about stimulus money; it is about the survival of your business." What happens to your business when access to your patients is controlled by a patient-centered medical home and you don't qualify to participate therein?

At phase 5, it's important to trace all the way back to phase 1. Despite its possible flaws, questions and concerns, if you want to be on the inside of the new payment model, you must have passed successfully through phases 1 to 4. You need EHRs so you may communicate (electronically exchange protected health information with other providers) ... so you may participate in team-based care delivery ... and be accepted onto coordinated care teams ... and be one of the providers who participates in the distribution of bundled payments and shared savings.

Without question, these are alarming statements. Be assured though, no crystal ball was required to see it coming. The evidence and pilot projects that reveal the inner workings of the new delivery system are all around us.  We need only know what to look for and how to engage. Again, that's the raison d'être of the National Eye Care Communications Project. We're still in the early days of bundled payment models. There's time ... but no time to waste.

Alistair Jackson, M.Ed.

Jim Grue, O.D.