The American healthcare system has undergone significant change in the passing years. With the shift from fee for service to value-based care, every aspect of the healthcare system from service to account management system has been disrupted massively. But with the change impacting the reimbursement structure, taking the load off the payer as well as the provider, CMS presented assistance in the form of The Bundled Payment For Care Improvement in 2011.
“Over the past several months, CMS has signaled renewed interest in bundled payments including the possibility of additional mandatory participation for oncology and other providers. This has forced providers to reevaluate their strategy including the processes and technologies they have in place to reduce risk to their revenue streams as bundled payments become more ubiquitous.”
The aforementioned is an excerpt from the coverage done on CMS recently introducing specific changes to the bundled payment model, which to the surprise of its criticizers is being put into use in the healthcare organizations across the organization, in order to reduce the healthcare practice’s expense plaguing the nation. But with CMS first pioneering BPCI basic model, to moving on to comprehensive joint replacement model, then implementing the Oncology care model and now in 2018, launching the BPCI Advanced model. All these bundled payment progressions have been the source of several misconceptions looming the healthcare system market.
To help you figure out the regarding this healthcare’s financial aspect, let us discuss in detail what entails a bundled payment model?
- As nearly two decades ago, CMS coined the value-based care concept to replace the traditional fee for service system, with the vision to reduce the soaring healthcare costs in the USA; an alternative payment model came into being. This payment model, known as the bundled payment arrangement was devised to significantly reduce the financial risk, which the providers are vulnerable to with the implementation of value-based care, which despite its intention to promote quality health care and be a cost-efficient healthcare care and payment model, is still in its nascent stage and have several hurdles to cross. This has placed the healthcare providers in a financial riskier position, as of now.
- Under the Medicare Access and CHIP Re-authorization Act, Healthcare bundled payments BPCI is widely accepted as an alternate healthcare payment. This payment model is further branched in four strategized model, wherein the payments to the healthcare service providers are made per episode to keep the cost under control without compromising on the quality. An episode refers to the care delivered for a specific health complication or treatment done within a defined period.
- In 2018 CMS brought about transformation in the BPCI with the introduction of BPCI Advanced, which compared to its predecessor, focuses quantitatively on the quality of the care being given to the patients. Unlike the previous bundled payment model wherein the participating healthcare body had the option to choose from 30, 60 and 90-day bundles, BPCI advanced has made the 90 days bundled method the only way. This new implementation also has a fewer exclusion, shifting the responsibility of those expenses which can not be controlled by the physician or the healthcare organization.
As the healthcare system evolved, so did the CMS BPCI Model; transforming with CMS receiving flak for not developing and implementing a more unbiased model. The BPCI under which several mandatory payment models were implemented was criticized for not being flexible to the providers. The healthcare system experts divided on the implementation of bundled payment methodology, between whether the mandatory or the voluntary would yield a more cost-efficient yet qualitative result?
The voluntary bundled payment can be proven useful in determining the impact on a smaller scale, for instance, when small to medium scale providers have to reap benefits from an alternative payment model. On the other hand, the mandatory bundled payment can be utilized where APM has already shown positive results by transforming the respective healthcare organization’s landscape into a cost-efficient and qualitative system. Industry experts believe both the payment model despite serving an individual purpose can benefit from improvement in the long run.
Meanwhile, what can be done to enhance probability of financial success with the implementation of bundled payment structure?
- As technology advances, the bundled payment structure can be optimally implemented to ensure financial success. Healthcare organizations can leverage data analytics to gain insight into the cost related intricacies through a safe and secure platform, helping adequately manage the revenue cycle.
- Not that it needs to be mentioned, but providing the patient with an interactive platform to be able to take necessary payment related action at the right time and also stay abreast with how policies can help them make a more informed decision, thereby giving the provider more intel and space to enrich their healthcare experience.
- The goal is the ultimate hurdle with the bundled payment structure. The ambition to dispense quality service by cost-efficient means, might seem doable but the practicality of it can be the biggest challenge to the providers unaware of the unexpected and add-on expense such as patient’s reluctance to follow the protocol such as high-cost patients, which escalate the financial risk which can be mitigated by identifying and judiciously allocating resources to the high-risk patients. This way the cost can be minimized with careful and improved infrastructure coordination.
The healthcare environment is continuously evolving, with CMS implementing transformation to make it more compassionate and affordable, for both the payers and the providers.
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