Bundled Payments Flashcards
1
Q
Bundled Payments
Provider Advantages
A
- Cooperation of physicians to reduce hospital cost
- Opportunities for reducing expenses
- Improving delivery system integration
- Gain-sharing between hospital and physicians
- Increasing profit margin
- Increasing patient volume
2
Q
Bundled Payments
Payor Advantages
A
- Reduce payments for services within bundle
- Encouraging patients to use lower cost, higher-quality providers
3
Q
Bundled Payments
Data For Analyzing Bundles
A
- Based on payor cost (provider reimbursement)
- Hospitals with accounting systems can best model potential savings
4
Q
Bundled Payments
CMMI Bundled Payments for Care Improvement Initiative
A
- Invites orgs. to apply for bundled payments for Medicare
- 4 Bundle Options
- Vary by included services, time frames, and prospective/retrospective payments
5
Q
Bundled Payments
Medicare ACE Demostration
A
Medicare 3-year demonstration program for Acute Care Episodes (ACE)
- Involved competitive bids for select IP procedures
- Medicare shares its savings with the participating sites as well as with patients
6
Q
Bundled Payments
Considerations in Contracting for Bundled Payments
A
- Define Episode
- Catastrophic Risk
- Financial Stability for Low Case Loads
- Determining Provider Allocation of Funds
- Case Severity
- Quality Outcome Requirements
- Admin Complexity
- Risk-Sharing Alternatives
- Potential for Increased Utilization
