Praise for Patient-Centered Payment Models, Bundled Payments
By - The Centers for Medicare & Medicaid Services (CMS) apparently gets a big thumbs up this week. Leading consumer advocacy group, the National Partnership for Women & Families (NPWF), openly praises CMS for its efforts regarding patient-centered payment models.
According to Debra L. Ness, NPWF President, CMS’s initiatives testing patient-centered payment models, such as the Comprehensive Care for Joint Replacement payment model, may result in economically efficient and simply better coordinated care. Says Ness, “This kind of innovation is a positive and promising step toward a health care system that rewards value instead of volume and treats patients and families as partners in health care decision-making.” Ness says it is essential that bundled payment models utilize transparent quality metrics and patient-reported outcomes to establish high patient outcomes.
According to CMS, these bundled payment initiatives, which pay providers via a retrospective bundled payment arrangement, allow for greater adaptability. Says CMS, “Through the Bundled Payments initiative, providers have great flexibility in selecting conditions to bundle, developing the health care delivery structure, and determining how payments will be allocated among participating providers.”
“As alternative payment models like the Comprehensive Care for Joint Replacement roll out, we will continue to educate consumers about the potential benefits, and help patients and families understand and engage effectively in their care,” Ness states. “But it is essential that Congress continue funding CMS to develop and test these new models of payment, so that we can continue moving toward a health care system that is truly patient- and family-centered,” she adds.
New considerations as patient-centered care moves to the forefront
The Department of Health and Human Services (HHS) established a goal of tying 90 percent of Medicare payments from volume to value within the next 3 years. Objectives across the industry are shifting.
Patient-centered care depends on a variety of factors to execute smoothly. Three of these related factors, as EHRIntelligence.com reported, are patient involvement, experience, and involvement. There is a tangible connection between a strong patient voice and strong financial performance, EHRIntelligence.com confirms.
Regarding the aforementioned Comprehensive Care for Joint Replacement payment model, inpatient surgeries that account for knee and hip replacements are the most commonly reported surgeries among Medicare beneficiaries. The Comprehensive Care for Joint Replacement aims to improve overall quality and coordination of care, according to CMS. A focus on advancing quality care while keeping costs low is vital. As RevCycleIntelligence.com recently reported, the hospitalization costs within one year for such inpatient surgeries topped $7 billion.
Will patients continue to receive high quality care as the pendulum shifts from volume to value? There are several hiccups along the way that require addressing. It is feasible those hospitals with the sickest patients will not find benefits in such a payment model. It is also possible hospitals will face penalizations via Medicare and that the quality of a patient’s recovery will take precedence where dollars and cents are concerned.
It is, nonetheless, hopeful praise for CMS will garner beneficial results down the healthcare road.
