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Another Medical Payment Paradigm Shift
[By Ann Miller; RN, MHA]
“Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius — and a lot of courage — to move in the opposite direction.”
Currently, the Centers for Medicare and Medicaid Services [CMS] pay hospitals a single prospectively determined amount under the inpatient prospective payment system [IPPS] for all care given to an inpatient. Physicians who provide other care to patients are paid separately – accordingly to a Medicare physician fee schedule – for each service they perform http://www.HealthDictionarySeries.org
The ACE Project
A newer project, called the Acute Care Episode demonstration, will soon test whether a global payment will better align the incentives for both types of providers leading to better quality and greater efficiency; beginning in January 2009 www.HealthcareFinancials.com.
Bundled Payment Advocates
Like Einstein’s statement on simplicity, we are believers in bundling payments for medical providers. If done correctly, episodic medical care bundling may be an acceptable compromise for all. The current Medicare payment system treats physicians like virtual offending criminals. Every potential health claim is fraud; although this situation probably wouldn’t change. Any formula that buries E&M coding is a system worth evaluating. Many docs easily double the number of patients seen if paperwork and documentation was not so onerous. Not sure this is always a good thing; however. Bundling forces physicians to reevaluate, what is necessary and what isn’t. There is a much unnecessary productivity in medical care. “Too much friction – not enough movement”
Assessment
Fee-for-service medicine has a way of creating business that need not be created. Will less be done under bundled care – will diagnostic care be upgraded for increased reimbursements? Will episodic coding consultants come out of the wood-work? Maybe! And, can we can look at the DRG and MS-DRG experience as a potential harbinger of the future?
Conclusion
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Filed under: "Doctors Only", Career Development, Insurance Matters, Managed Care, Op-Editorials, Practice Management, Research & Development | Tagged: bundled payments, episodes of care |
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FFS fragments medical care, the co-ordination of care, and the payment for care
On the other hand, with capitation we’ve essentially replaced fee-for-service payment, in which everyone thinks about their own piece of the pie, with a payment scheme in which everyone is “just doing their job” and expecting the system to take care of the rest.
Maybe EoMC is a better way?
Dirk
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Hospitalists and Bundled Payments
A hospitalist group is arguing for CMS to wait until there’s some real-world evidence on what works with bundled payments with EoC before health reform.
The organization, the Phoenix Group, argues that policymakers should pay close attention to the results of HHS’s Acute Care Episode (ACE) Demonstration project,
So, here is the link from CMS:
http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?filterType=none&filterByDid=-99&sortBYDID=3&sortOrder=descending&itemID=CMS1204388&intNumPerPage=10
Charlie
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More on Bundled Healthcare Payments
Charlie – Bundled payments may help facilitate reform efforts through lowering overall costs for healthcare by simplifying reimbursement and administrative systems, and encouraging integration between providers of various specialties. (Read more…)
Click to access bundling.pdf
Source: Health Capital Consultants, LLC
St. Louis, MO
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EoC
Increasingly, some heatlhcare systems are now billing by the episode of care. The DRG assigned to the EOC will determine what CMS will reimburse.
Under this system a hospital is reimbursed based on the diagnoses and what standard payment is for that so this is actually incentive to order less expensive tests and treatments.
While this might be good for the insurance companies and the patient, it often puts hospitals in the red. Small community hospitals can especially suffer.
Dr. David Edward Marcinko MBA CMP™
http://www.CertifiedMedicalPlanner.org
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