How You Can Turn Bundled Payment Risks Into Opportunities

Last week, the Centers for Medicare and Medicaid Services (CMS) announced the addition of three new bundled payment initiatives. The proposal shows how CMS is moving towards value-based payments by making participation in certain regions mandatory for the following conditions:

  1. Acute Myocardial Infarction (heart attack)
  2. Coronary Artery Bypass Grafts
  3. Treatment for Hip or Femoral Fracture

Regarding the Acute Myocardial Infraction and Coronary Artery Bypass Grafts, CMS states that the additions can be attributed to its efforts in trying to improve prevention and treatment of the top cause of death and disability in this nation. In fact, heart attacks and strokes cause 1 in 3 deaths and result in over $300 billion of health costs per year.

Although these efforts are trying to admirably support risk assessment and cardiovascular disease prevention, the additional bundled payments can be seen as both a risk and an opportunity for providers. The purpose of the bundled payments is to promote high quality care, and the system rewards providers that care for patients during the entire care episode under a predetermined cost. Conversely, if a hospital goes over the predetermined budget, it is required to pay the difference back to CMS

The procedures that fall into the new proposal generally affect patients that are already at an increased risk for complications. This puts physicians in a difficult situation, as they have far less control over the timing and planning of the surgery. As a result, many physicians feel this  could jeopardize the fiscal well being of their hospital or practice.

Pushing back against the new CMS changes will prove to be difficult, as CMS is moving to expand the bundles program even further over the next few years. Yet there are ways to help ensure financial success and patient satisfaction. By preparing for the bundled payment transition now, hospitals can start to improve outcomes and understand areas for efficiency across the patient journey.

One such area is the communication between provider and patient during the pre-visit. CipherOutreach, our patient outreach solution, empowers providers to follow up with 100% of patients to alleviate any confusions patients might have with their specific procedure. This step can prevent any avoidable complications during the surgery. Once the surgery has been completed, monitoring a patient’s stay at the hospital is essential. With CipherRounds, our digital rounding solution, providers can easily stay up to date on every patient and his/her needs through automated alerts, notifications, and checklists. When the patient is ready to be discharged, providers are tasked with giving the patient instructions for proper self-care while avoiding readmissions. CipherOutreach once again can assist nurses or a care management team by ensuring that every patient receives a prompt follow-up call.

As the only technology company that delivers a comprehensive bundled payment solution that spans the entire care continuum, we are here to help set you up for success. For more information on how we can help you on your bundled payment journey, contact us today.

John Banks Powell, VP of Post-Acute Strategies, obtained his Bachelor’s from UNC-Chapel Hill and his Master’s from Duke University. Powell spearheads CipherHealth's post-acute and bundled payment initiatives by partnering with providers across the care continuum. When Powell isn’t helping post-acute providers reach organizational goals, he can be found 30,000 feet in the air piloting planes.