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The Center for Medicare and Medicaid (CMS) have concluded that they can now cancel the mandatory hip fracture and cardiac bundled payment model which operated under the CMS innovation center and implement changes. It would now all be included in the Comprehensive care for joint replacement (CJR) model. The new setting will benefit the hospitals which would provide care for Medicare Patients.   

CMS has always believed that the bundled payment models will offer better opportunities to improve the quality and care while coordinating with lower spending. Focusing on developing different bundled payment for CMS and engaging varied providers is one of the best ways to drive health system change to minimize the cost and maintain care.   

CMS has also decided in reducing the geographic area which would be participating in CJR from 67 areas to 34 areas. The need of addressing unique rural provider challenges CMS has decided to make the participation voluntary for low volume and rural participating in the CJR model for all the geographic area.

The regulation will also have an interim final rule for the areas which are impacted by uncontrollable and extreme conditions. This comes as a relief for the providers who are more prone to hurricanes and fires.

CMS will also be finalizing the cancelation of other bundled payment used for hip fracture and cardiac payment which also had an incentive payment model. The model was scheduled to begin from January 1, 2018. The flexibility provided will also arm the CMS with greater flexibility to design and look to test better innovations to improve the quality and care to implement to care coordination across inpatient and post-acute care spectrum.

Currently, as CMS readies itself for revamping the current bundled payments to invite better innovation into providing care and reduce the cost. Ambulatory Surgical Centers (ASC) will be the center for providing such innovation.

Dr. Steve who heads an Ohio emergency center “Providing quality care is never a problem for the providers for us the main issue was the inclusion of bundled payment which would suddenly mean that a specialty physician has to multitask more to cover more patients. For any ASC facility, this would mean the patient would not get a required care because the bundled payment reduces the time spend by a doctor.”

“For us, the driving innovation should never be just to reduce cost it should be patient care. The secondary goal could be reducing the cost but with bundled payment, emergency care providers could come under a serious threat. ”

Medical Billers and Coders (MBC) hosts around 72 different ASC who provide emergency service to patients. Bundled payment is not a comprehensive way of reducing the core problem of better patient care and to do this at an affordable rate we need to take into consideration various constraints of cost for the providers. A provider cost would depend on the complexities of the patient health and bundled payment would make it ineffective to convey to payers. As MBC differentiated different systems for payment according to the regulations laid down by the payers (insurance companies) we providing the channel have to regard various challenges laid down in medical billing.

Published By - Medical Billers and Coders
Published Date - Mar-28-2018 Back

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