A new trial payment model for health care

david52 Zone 6February 8, 2013

"Colorado hospitals are diving deep into federal experiments with "bundled" payments, where the government writes one check for a coronary bypass and the hospital sorts out who gets paid what, from doctors to a home-health nurse.

These growing arrangements also put the hospitals on the hook if all the heart services, for example, add up to more than Medicare agreed to pay, and if they fail to deliver quality care.

"All of these experiments do introduce that notion of risk," said Steven Summer, president of the Colorado Hospital Association. The pilot programs are vital, he added, to moving away from the traditional one-fee-for-one-service model that fed health-care inflation.

Medicare expanded the hospitals taking on bundled payments last week, with various phases in at least three Colorado systems:

- Penrose-St. Francis in Colorado Springs, part of the Centura Health hospital network, is working with Medicare on congestive heart failure and coronary-artery bypass. Penrose and Medicare will start by comparing charges for everything related to a hospital stay for bypass - including nonacute care afterward - and compare them to a target.

In later phases, the hospital would get a bundled payment at a discounted price and then keep savings or lose money depending on outcomes and hitting patient quality goals.

- Exempla's three metro hospitals, part of the SCL Health System, have tested earlier phases of the bundles in cardiac care and now will expand into hip and knee operations and other procedures.

- University of Colorado Hospital, the anchor of a fast-growing six-hospital system, will join with its University Physicians group for bundles in providing cardiac care.

"We anticipate bundled payments for every procedure" in the future, said UCHealth president Rulon Stacey.

With U.S. health-care costs at nearly 18 percent of gross domestic product, and an aging population promising to make Medicare an even bigger portion of the federal budget, reform advocates say old payment systems are doomed. Medicare is also piloting programs where it pays doctor-and-hospital collaborations bonuses if they reduce the predicted annual cost of care for a patient's entire needs.

Many hospitals are hiring more physicians as in-house employees to better control costs and coordinate care. Hospitals will also have to do a better job negotiating prices and using supplies such as high-priced stents, and avoiding duplicating services such as MRIs, said Exempla vice president Debbie Welle-Powell.

Advocates say the systems differ from past, much-maligned models of "capitated" care, where gatekeepers had a set budget per patient and lost money if they deviated from it. Those models were based only on cost, without rigorous quality and patient- satisfaction mandates from government watchdogs, Stacey said.

Medicare will demand quality with its power of the purse, said Welle-Powell. Even if a hospital racks up $500,000 in a Medicare reward fund for savings on the bundles, "if quality metrics aren't met, there's no distribution of that reward," she said. In cardiac care, quality measures would include mortality, infection rates, readmissions and other factors." end quote

Its an interesting attempt to get spending under control - I can see the pro's and cons of it, but the kicker is that payments are tied to a satisfactory outcome, IOW if the patient isn't happy, the hospital is penalized.

Here is a link that might be useful: link

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marshallz10(z9-10 CA)

Tort Reform! I can hear the cries now coming from those blaming high cost of health care on lawyering.

Think of the reduced cost of accounting by not having to meet the many and varying needs of insurance company accountants.

    Bookmark   February 8, 2013 at 12:37PM
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marquest(z5 PA)

I think they have started to find the sweet spot of making the patient happy. I am caring for two senior family members. They are both using one of our local Hospital that is more corporate than patient care. From previous admission into this facility the following changes are now happening.

Meal----Patient is given a menu and they dial 0 for the dietitian and order their meal and request a time of delivery. If they request something on the menu that is not approved due to medical diet no, no the dietian explains and gives the patient the altenate choice.

Nursing----These are the nicest, pleasant, human being on earth now. In the past at times I thought if they felt like it they would throw the patient out of the window they were so nasty and uncaring. Now there are greetings when they enter the room, ask the patient pertinent health questions and encouragement of getting well.

Staff Doctors----Call the patient contact person when they go into the room for follow-up. Because both of my family members have private doctors on staff at the hospital, the staff doctors do not have a valid need to look in on the patient but a hospital requirment because of liability.

In the past these staff doctors would talk to the patient and leave the room and the elderly patient tell their caretaker what the doctor said. Many times because it was coming from an elderly patient you got the wrong info. as the elder really did not know what the doctor was saying.

I hope to see more positive results of better health care from these corporate hospitals.

    Bookmark   February 8, 2013 at 1:04PM
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