Orthopedics billing services

How to manage Orthopedic Bundled Payments?

In a bundled payments model providers and/or healthcare organizations receive a single payment for all the services delivered during an episode of care. When it comes to orthopedics, bundled payments are becoming more sophisticated and standardized with the help of analytic insights based on collected data from the surgeons.

CMS has made numerous changes to the Bundled Payments for Care Improvement Advanced program for 2021 that will have a significant impact on participants where these participants are no longer able to select individual episode types, such as lower extremity, upper extremity, or spinal fusion.

Orthopedic bundled payments are rising due to various benefits such as lower cost, structure, specialist engagement, improved quality, and attainment of organizational goals. Moreover, Orthopedics is the most important service line for most hospitals, and joints are the mainstream of revenue generation for healthcare providers.

Various lucrative benefits attracted physicians to participate in bundled payments program however, you should know its management to avoid various challenges like withhold care from those who require more resources than the bundle allows, such as those from a lower socioeconomic status.

Following suggests recommendations can be helpful to you to manage Orthopedic Bundled Payments:

Identify opportunities to reduce patients’ risk before surgery

The hospital estimated financial risk for complications and mainly for those that lead to increased post-acute charges under bundled payments. Orthopedic surgeons should direct preoperatively risk assessment tools to identify opportunities to reduce patients’ risk before surgery by helping patients control their diabetes or by treating pre-existing Staphylococcus aureus colonization.

Build robust data system

Even after months of service delivery, the federal government reconciles episode costs and payments retrospectively hence providers must carefully track utilization and expenses in real-time to manage an episode of care. A robust data system enables hospitals to respond proactively to issues that could lead to a poor outcome and/or increase costs.

The established data systems can help to capture the cost of all aspects of care, including pre-admission testing, implants, or any other materials used during the procedure, the inpatient stay, services provided during the 90 days after the hospital stay, and any stakeholder payments.

Optimizing care episodes

You can optimize care episodes with the help of cost and outcome variations across an institution as variation analysis can identify and reduce unnecessary waste. Data often show no correlation between high costs and superior patient outcomes and providers who are outliers in terms of episode costs can often be persuaded to adopt more efficient practice patterns. Both efforts help to control costs which is an important discipline under bundled payments.

Ensure quality measures

Cost control is an important discipline of bundled payments. However, quality measures are also an essential component of these programs. Three principal quality measures from CMS are the hospital-level risk-standardized complication rate, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results, and patient-reported outcomes. Hence to perform well under bundled payments, hospitals must work to optimize care quality and patient outcomes.

Stakeholder management

If you want to be successful in orthopedic bundled payments then you need careful management of various stakeholders like physicians, nurses, ancillary staff, and post-acute providers. The alignment of various stakeholders must be the primary objective of Hospital administrators and orthopedic leaders to achieve the mission and goals of the bundled payment program. Moreover, interdisciplinary leadership teams are organizing clinical units which help to offer coordinated services across the episode of care.

Finally, you need to understand that CMS has been clear that bundles are here to stay, and CMS has already signaled for a much broader and all-encompassing mandatory bundled payment program. Hence management of these bundled payments is also crucial.

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