Bundled payments represent a form of APM (alternative payment models). They are created to offer value-based care by allowing providers to increase efficiency during patient care while improving revenue performance at low overhead costs.
Bundled payments are a kind of episode payment model (EPMs) that require the providers to take risks and go above the decided costs of a patient’s care to eliminate hospital readmissions and complications by establishing a low cost, high quality continuity of care.
Bundled payment challenges
Here are some of the challenges associated with the risks involved in bundled payments:
Managing healthcare bills that are not in the provider’s control
The main challenge or risk involved is covering the patient’s treatment costs that might not be covered by the healthcare provider. An example is a patient’s behavior or lack of medication adherence that could lead to adverse consequences in the future, despite a physician’s best effort.
Taking advantage of post-acute partnerships to manage the treatment costs
Unprocessed medical claims billed over 90 days after surgery, treatment, medical procedure or post-acute quality patient care might adversely impact the success associated with the bundled payments.
Offering partnerships with post-acute facilities that offer low-value care could put the cost savings under risk. Finding the right partners is crucial for a continuum of high-value care, otherwise choosing an alternative model like bundled payments can become unfeasible for healthcare facilities.
Providers benefit from the bundled payment model
One way to succeed and get maximum revenue from the bundled payment model is to improve communication and establish a healthy connection with the providers.
The healthcare providers must execute and offer efficient coordination with the hospital staff and implement successful strategies to ensure that all the patients are being treated optimally under their supervision.
This could help avoid any extra expenses and hefty adverse events.
CMS BPCI Advanced Medicare Bundled Payment
The Bundled Payments for Care Improvement (BPCI) was established in 2013 as testing grounds to discern which of a plethora of disparate value-based payment models would successfully produce greater quality and care coordination at a lower cost point to Medicare. The BPCI Advanced initiative carries on the efforts of the BPCI program, with select changes, so to further drive the establishment of value-driven bundled payments to healthcare facilities.
Bundled payments for a permanent fixture in the health care department
With the help of collective training and knowledge from early pilots and practitioners, more and more healthcare providers, nurses, and care providers are exploring various angles of bundled payments for potential rewards.
There are various advantages associated with bundled payments. Not only does it give the providers strong incentives and reasons to reduce their costs, but it also incentivizes them to proactively prevent potential complications.
It can also encourage partnerships and collaboration across various healthcare institutes and providers. Even though bundled payments have certain setbacks, it does offer a way to implement quality care and development that follows evidence-based guidelines to reduce spiraling healthcare costs.