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Case Study in Bundled Payments: The Baptist Health System Experience
Healthcare Intelligence Network, Sep 2011, Pages: 23
Considering participation in the Center for Medicare and Medicaid Services new Bundled Payments initiative? If so, Case Study in Bundled Payments: The Baptist Health System Experience is essential reading before filing letters of intent by CMS's September or November 2011 deadlines.
This 23-page report documents the care payment experience of Baptist Health System as a participant in the CMS Acute Care Episode (ACE) demonstration pilot, which aligned payment for services delivered across episodes of care or 'bundled' care. ACE focused on the cardiac and orthopedic diagnosis-related group (DRGs), two of the public payor's most frequent and largest cost disease areas.
Data from the ACE demonstration helped to lay the groundwork for the new Bundled Payments program.
A major player in the cardiac arena, having a little over a third of the cardiac market share, Baptist Health saw in the ACE demo an opportunity to gain market share, align providers in quality and efficiency efforts, and improve patient satisfaction. It signed on to be one of five healthcare systems in the ACE pilot.
In Case Study in Bundled Payments: The Baptist Health System Experience, Baptist Health System Senior Vice President and Chief Development Officer Michael Zucker, FACHE, outlines the San Antonio-based five-hospital system's motivation for participation, the key principles of the ACE demonstration, the challenges and benefits and success strategies and lessons learned from the ACE demonstration — as well as the 'Hallmark moment' of distributing gainshare checks to participating providers.
Zucker provides a frank look at the challenges of structuring payments, adjusting for severity, engaging physicians and vendors, coordinating and negotiating services and preparing for transition to real-life application.
Like the ACE program, the upcoming Bundled Payments program is designed to align payments for services delivered across an episode of care, such as heart bypass or hip replacement, rather than paying for services separately.
The fall 2011 Bundled Payments program, greenlighted by the Patient Protection and Affordable Care Act, outlines four broad approaches to bundled payments. Providers will have flexibility to determine which episodes of care and which services will be bundled together, making it easier for providers of different sizes and readiness to participate in this initiative.
Organizations have until September 22,2011 to apply for participation in Model 1, and until November 4,2011 to declare intent for Models 2, 3 or 4.
CMS says bundled payments will give doctors and hospitals new incentives to coordinate care, improve the quality of care and save money for Medicare.
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