Monday, July 12, 2010

Bundled Payments To Start Next Year

Doctors better make nice with hospital systems since it looks like bundled payments to "Accountable Care Organizations" in Illinois will start very soon (emphasis mine):
The federal Medicare program will test lump-sum payments, known as "bundled payments," in certain markets, and probably wouldn't adopt them more broadly for years. But Chicago hospitals need to hurry: Blue Cross & Blue Shield of Illinois aims to roll out bundled payments in contracts with some hospital systems and physician groups starting next year.

The city's dominant insurance carrier expects that by the end of 2011, 10% of its membership will be covered by contracts that pay providers on an episode-of-care basis, says Steve Hamman, the insurer's vice-president of network management. UnitedHealth Group Inc., the No. 2 insurer in Chicago, also plans to test bundled-payment here and elsewhere, Chief Medical Officer Sam Ho says.
For patients who present with more than one medical problem at a time, please be kind enough to notify your doctor which payment bundle you'd like them to address, since only one payment per patient per episode of care will be permitted.



Anonymous said...

Goodness! Bundled payments have been in place for years in CA!

We admit someone for a 3-vessel bypass & the guy goes into renal failure, strokes, whatever - we've been reimbursed based on the 3-vessel bypass only. The rest of it is sucked right out of that reimbursement.

Thats the whole basis for good care & finding doctors & institutions that manage & choose appropriate patients. Does that mean some poorer candidates are bypassed - you bet!

But, was that person really a candidate for the surgery/procedure in the first place? Hard question, but finally we're at the point when that hard question must be addressed.

This makes procedural specialists take a good hard look at the patient & not just the procedure...

shadowfax said...

Yeah, I am really interested to see how this bundling thing works. How do you bundle for a patient with, let's say, rapid A Fib who presents to the ER? There's a facility fee, an ER doc, a follow up primary care doc and a cardiologist, maybe an echo in some cases. How do you divide that baby and how do you ensure the Big Dog (i.e. the hospital) won't just keep the lion's share? And who decides?

It's like the old joke that democracy is three wolves and one sheep voting on what to have for lunch. Except in this case it's one really big wolf and three sheep.

Here we go...

DrWes said...

shadowfax -

Once you're an employee of the Big Bad Wolf, your chunk will be your salary.

The problem with the Grand Plan of health care reform as envisioned by the Central Authority, of course, are those pesky large doctor groups that have elected to stay separate from hospital systems. For them, a new tactic will emerge (it's still to be determined) - either doctors who refuse to take government payment rates instead of their own market rate will be (1) tried as conspirators against the government or (2) a law will develop that requires acceptance of Medicaid and Medicaid payment rates as a requirement for medical licensure in the state.

Problem solved.

Anonymous said...

wes, I have a thought for a new post for you. check in your area to see if it is true. I am an EP cardiologist in the south. I just found out today Medicare will not reimbursement for consults and follow ups if another cardiologist is following (only one cardiologist per person). Example: I was consulted for tachy-brady for pacemaker by a cardiologist. I changed the medications and avoided the pacemaker. My reimbursement for care for new consult and 3 follow up days: zero. I see our subspeciality having some real problems soon.

Toni Brayer, MD said...

For another look at bundling and how insurers pay as little as possible to primary care physicians, check out my latest blog at:

Great post, Dr. Wes.