What Are The Four Major Drawbacks Of Bundled Payments

Because the rate all payers pay are generally the same (by categories of procedure), providers have no incentive to compete and provide better service. Providers who provide higher quality care are rewarded just as much as those who provide lesser quality care. Even though an all-payer system would shift provider's focus from the patient's socio-economic status, it would eliminate the incentive to improve the quality of service as the reward for quality is limited to morality, not money. A possible solution of this is to have an all-payer system, with adjustment to rates based on the quality of health care provided (rather than inflating some payers to cover the discounts of payers who pay

Bundled payments create financial incentives for providers and benefits patients. Providers will be influenced to coordinate care for the entire service provided, pre-operation, during, and post-operation. This program will benefit the patients in eliminating costs that do not benefit them or relate to their care. For example, patients can be directed to use home care as opposed to institutional care if suitable.

The goal of the initiative is to increase efficiency of care, improve quality of care, and lower costs. This initiative consists of four different bundled payment models. The first three bundled payment models are retrospective payment arrangements based on patients’ historical data. However, the fourth model is proposed for the future. Centers for Medicare & Medicaid Services (CMS) make a single bundled payment to the hospital for all services during inpatient stays for hospitals, physicians, and other medical professional specialists.

I agree, physicians run the risk of non-payment and persuading them to adopt this payment system is challenging. Additionally, physicians are concern of complications that may occur outside the episode-based payments—how would they get paid and should they be paid separately. Finally, physicians are subject to losing patient’s if they opt out the bundled payment system to others that adopted the plan.

A mixed payment system combined with physician monitoring, will provide physicians with incentives to consider costs and benefits of different treatment options, which will lead to an efficient level and quality of care. (1,2)

This system most importantly will save Americans money. With common nuisances like premiums, co-payments, and deductibles eliminated leaves us Americans with more money in our pockets. Statistically speaking 95% of all households would save money. A patient shouldn’t have to be denied treatment because of the inability to provide out of pocket fees for medical services.

The Improving Medicare Post-Acute Care Transformation Act (IMPACT) standardizes data collection and data sharing among post-acute providers. The IMPACT Act is part of the Centers for Medicare and Medicaid services (CMS) effort on basing reimbursement on quality as it moves from voluntary reporting of quality measures to mandatory reporting, basing reimbursement on the data reported. Presently, post-acute providers are paid on a fee-for-service basis but with the IMPACT act, bundle payment will replace the fee-for-service. The bundle or value based payment pays for outcomes and not for the volume of services. The Act gives post-acute providers an incentive to work on

The viewpoint of their proponents, there is a difference from historical managed care arrangements in ACOs predominantly HMOs since they are centered around providers ahead of insurers and usually are not detained at complete monetary peril for the price of health care. In an ideal world, ACO payment approaches will include improvements in quality of care measurement that take into account the range of service delivery ACOs are designed to provide. If legislated, nationally health reform could most likely include more or less research with ACO incentives. On November 7th , 2009 the United States House of Representatives passed, the Affordable Healthcare for America Act (H.R. 3962) which called for pilot payment incentive that would encourage ACOs in both Medicaid and Medicare, along with other policies on payments alterations and authorized demonstrations and pilots (Huntington, Covington, Center, Covington, and Manchikanti,

They will now receive payments from the quality of care they provide to their patients. Those with higher based value will receive higher payments than their counterparts (Berenson 2010). I think this is very important because the healthcare system has been volume driven for so long that quality healthcare has been an issue for quite some time. In addition to value, this would definitely improve quality and efficiency needed for better patient outcomes.

Single-payer health care would also improve the ease with which people receive competent health care. A single-payer health care system with a streamlined means of receiving and paying for medical care would save valuable time and money as compared to our current health care system, which is bogged down in a morass of complex and varying insurance forms by indifferent insurance companies. The complexity could lead one to think the insurance companies would be more than happy to simply not make payments after their customers have received the required care. The administrative cost of dealing with so many varied insurance companies alone is exorbitant, “$82,975 per physician per year spent in the United States”(Morra et al. n. pag). Nearly

Accountable Care Organizations – “ ‘National Pilot Program On Payment Bundling’ - The Secretary shall establish a pilot program for integrated care during an episode of care provided to an applicable beneficiary around a hospitalization in order to improve the coordination, quality, and efficiency of health

The ACA programs are a fee-for-service reimbursement into expenditures for comprehensive bundles of care that authorizes the National Pilot Program on payment bundling in Medicare, which will increase efficiency in the delivery of care and consequently

Any proposed policy to improve healthcare must address the current payment method, and the rising cost of healthcare. The common reimbursement method for healthcare services is the fee-for-service payment model. It requires providers to figure-out all incurred costs to render services for patients. Additionally, providers need to determine what is the insurer proposing to pay, which thought to reward quantity over quality. An alternative to this model is using a bundle

Unnecessary services are provided far too often because there is little coordination across sites or among providers, yet care management, cross disciplinary care, and preventive care are often uncovered or poorly reimbursed. Notably, 45% of the U.S. population have chronic conditions requiring care management. Of this population, 60 million, or roughly half of those with chronic conditions, have multiple conditions. Current care delivery systems are not designed to support the care of these complex patients, which requires multiple providers and services.

The first example of a cost containment option is provider payment reform. Therefore, the provider payment reform consists of changing provider payments from a fee-for-service system to a value-based payment system (Grinsburg, 2013). As a result, health care providers will be rewarded for increasing quality while reducing health care costs (Grinsburg, 2013). In addition, the new payment reform will reimburse health care providers for care coordination and patient education services that are not reimbursed under the current fee-for-service payment system (Ginsburg, 2013). Overall, value-based health care services tends