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By Eric Bricker MD
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Filed under: "Doctors Only", Accounting, Ethics, Experts Invited, Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc., Risk Management | Tagged: Accountable Care Organizations, ACO, bundled payments, capitation, Eric Bricker MD, fixed medicare payments, HMO, medicare, value based care, VBC | Leave a comment »
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BY ERIC BRICKER MD
Reimbursement Typically Takes the Form of a Bundled Payment or a Lower Rate of Fee-for-Service.
Employers with Greater Than 500 Employees Tend To Engage in Direct Contracting.
Mid-Market Employers with a High Concentration of Employees in One Geographic Area Tend to Engage in Direct Contracting as Well.
The Employer Frequently Uses an Independent TPA to Process the Claims for the Direct Contract.
Also, the Employee Health Plan Changes the ‘Benefit Level’ Such that Care at the Direct Contract Facility is Often at $0 Out-of-Pocket Cost for the Member.
Engaging the Plan Members with Navigation Services is Helpful to Make the Experience Integrated with the Overall Health Plan Offerings.
YOUR THOUGHTS ARE APPRECIATED.
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Filed under: Experts Invited, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Videos | Tagged: bundled payments, direct employer contracting, direct reimbursement, Eric Bricker MD, health plans | Leave a comment »
Payor Savings Evidence?
New Evidence for Private Payor Savings Through Bundled Payments
A new RAND Corporation study on bundled payments in the private sector was published in the March 2021 issue of Health Affairs. The study analyzed data from over 2,000 procedures performed as part of a direct payment program by Carrum Health between 2016 and 2020, and found significant savings from this bundled payment program, without any significant changes in quality. This study adds important evidence to the argument in favor of bundled payments and is especially important because it examines the under-studied area of bundled payment models from commercial payment systems. (Read more…)
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Filed under: Health Economics, Health Insurance, Healthcare Finance | Tagged: bundled care, bundled payments, episodes care | Leave a comment »
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 | 4 Comments »
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