Basics of Bundled Payments in Healthcare

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• Basics of Bundled Payments in Healthcare

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Basics of Bundled Payments in Healthcare
Bundled payments represent one form of
alternative payment models (APMs) that are
designed to move toward value-based care by
incentivizing providers to advance coordination
and efficiency of care while also improving
quality and outcomes at lower costs. Bundled
payments, also known as episode payment models
(EPMs), require participant providers to assume
risk, as they must cover costs that go above the
target price for an episode of care including
those that arise from complications and hospital
readmissions. Challenges associated with bundled
payments 1. Managing Healthcare Costs Beyond The
Providers Control The major challenge with
bundled payments is managing costs for a
patients treatment that may be out of the
providers control, such as medication adherence
or other patient behaviors that could lead to
adverse events. 2. Leveraging Post-Acute Care
Partnerships To Control Costs With revenue on
the line for 90 days or more after a procedure or
diagnosis, post-acute care quality and costs may
impact bundled payments success. Partnering with
low-value post-acute care facilities could
jeopardize potential cost savings under the
alternative payment model.
Medical Billing Services in Oregon
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Basics of Bundled Payments in Healthcare
3. Providers Succeed In the Bundled Payments
Model One of the keys to success with the
bundled payment model is increasing provider
communication. Providers must execute efficient
care coordination strategies to ensure that
patients are being treated optimally at every
level of the episode to avoid expensive adverse
events. 4. Medicare Bundled Payments 2018 CMS
BPCI Advanced At the end of November last year,
the Trump administration canceled hip fracture
and cardiac care bundles that were mandatory
under the Obama administration. To reduce the
burden on rural hospitals, they also
significantly decreased the number of geographic
locations from 67 to 34 where participation in
the Comprehensive Care for Joint Replacement
(CJR) payment bundle was required. 5. Bundled
Payments A Permanent Fixture in Health
Care With the promise of the early BPCI bundles,
the governments recently renewed commitment to
these APMs, and the collective knowledge gained
from early pilots, more and more health care
leaders are exploring bundled payments potential
for reward.
Medical Billing Services in Oregon
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Basics of Bundled Payments in Healthcare
To avoid challenges associated with bundled
payments and to boost your practice cash flow
connect with our billing manager.
Medical Billing Services in Oregon