Advice for CMS Bundled Payment Participants: Physician Engagement a Must

Wednesday, August 31st, 2011
This post was written by Patricia Donovan

Continuous physician engagement and communication is a must in any bundled payment initiative, advises a veteran of the CMS Acute Care Episode (ACE) demonstration project. Organizations have until September 22 to apply for participation in Model 1 of of CMS’s newest bundled payments initiative, which seeks 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 application deadline for Models 2,3 and 4 is November 4.

Launched by the Center for Medicare and Medicaid Innovation Center, the program 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.

CMS says bundled payments will give doctors and hospitals new incentives to coordinate care, improve the quality of care and save money for Medicare.

The bundled payments initiative is based on research and previous demonstrations that suggest this approach has tremendous potential, such as the CMS ACE demonstration project. Baptist Health, a five-hospital system in San Antonio, Texas, participated in the ACE demo, which focused on the cardiac and orthopedic diagnosis-related group (DRGs), two of its most frequent and largest cost disease areas.

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.

Baptist Health System Chief Development Officer Michael Zucker, FACHE, outlined Baptist’s motivation for participation, the key principles of the ACE pilot and the challenges and benefits during a recent webinar on Medical Home Reimbursement: Exploring Bundled Payment Options.

Zucker offered this advice to organizations considering a transition to a bundled payments model:

Continuous physician engagement and communication is a must. No matter how much we’ve communicated, it hasn’t been enough, but it’s getting better. As we get more and more experience with the program, things are becoming more on autopilot. For example, we’ve developed care protocols for each of the DRGs. Initially, physician support of those protocols, even though these were evidence-based and best practice-defined protocols, was highly variable. But the physicians also realized that if they weren’t following the evidence-based protocols, they ran a higher chance of falling outside of the quality metrics.

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