Bundled Payments for Care Improvement Initiative: The Next Evolution of Payment Formulations: AAHKS Bundled Payment Task Force
Section snippets
Introduction: History and Overview of Bundled Payments
The current rate of healthcare spending in the United States is unsustainable. Various stakeholders such as the Centers for Medicare and Medicaid Services (CMS), government policy makers, hospitals, industry thought leaders, payers, and physician groups have been examining options to shift away from the current fee-for-service (FFS) model. This model encourages excessive delivery of services and results in an increase of both utilization of services and costs to the healthcare system. One
The Acute Care Episode (ACE) CMS Demonstration Project Experiences in Albuquerque (One Year) and Tulsa (Two Years) and San Antonio
With the purpose of improving quality and care coordination and reducing and controlling costs, CMS organized the Acute Care Episode (ACE) Demonstration Project focused on high volume and high cost THA and TKA in Medicare Fee-For-Service (FFS) patients. Patients in Medicare Senior Advantage Plans were not included in the ACE project. The project involved only four states: Colorado, New Mexico, Oklahoma, and Texas. Only one hospital system could be chosen per metropolitan service area (MSA). Two
Bundling: A Systematic Approach
A few essential elements are necessary to start a successful bundled payment program.
Redefining a Product with Enhanced Value: Perhaps one of the easiest ways to consider the implications and potential benefits of switching from a fee for service model of payment to a bundled payment model is to think about it from the perspective of a consumer of health care, rather than as a provider. Payers (insurers, employers, and patients themselves with increasing personal financial responsibility)
Gain-Sharing Within a Bundled Payment Environment
Definition: Gain-sharing is one mechanism that can be used to assist in delivering collaboration among physicians and hospitals [10]. It is a process or program that aligns the incentives of hospitals and physicians to improve the fiscal performance of the hospital and reward physicians for their effort. The Department of Health and Services Office of Inspector General defines gain-sharing as “an arrangement in which a hospital gives physicians a percentage share of any reduction in the
Summary
Given the changing political and economic climate in the United States, health care reform will continue the push toward the value equation emphasizing quality improvement and cost control.
It is unclear what form this change in health care governance will assume, but change is inevitable due to the budgetary limits that will be encountered over the next few decades. Initiatives that enable physicians, health care systems and payers to control costs, improve quality and efficiency, and increase
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The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.07.012.