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HFMA: Preparing for New Bundled Payments Part 2

Last week we covered the first four elements for structuring cardiac payment bundles. These included establishing clear and achievable goals, focusing on inpatient costs and reducing care variations, being guided by data and focusing on medication management and compliance.


The remaining three elements are:


Reorganize to manage post-acute spending. Effective cost management requires a decrease in readmissions. This makes robust care management a must for the organization.


Following patients through their hospital stay is not enough. Someone also must make sure they’re getting to follow-up appointments and that the care they receive at skilled nursing facilities or through home health providers meets the quality standards of the hospital.  (“How Providers Should Prepare for New Bundled Payments,” HFMA Leadership +, June 13, 2017)


For the subset of patients who are readmitted to the hospital, it’s necessary to understand exactly why and to closely track all skilled nursing and home health discharges, the quality of care that patients receive while being treated by another provider and their length of stay. (“How Providers Should Prepare for New Bundled Payments,” HFMA Leadership +, June 13, 2017)


Establish a strong post-acute provider network. Managing post-acute spending requires a performance network of providers who meet your quality and length of stay expectations.


To discourage unnecessary emergency room care, patients should have immediate access to clinics. Sometimes patients go to the emergency room because they can’t get a timey appointment with their physicians.


One expert noted that successful providers have set up immediate-access clinics that allow same-day appointments for patients who can be treated for follow-up issues by advanced practice providers or physicians. Another model has heart failure clinics monitor patients in an office setting before they’re sent home, and mobile paramedics traveling to patients’ homes to evaluate them on the spot or direct them to the most appropriate site rather than automatically taking them to the emergency room.


Gain stakeholder buy-in. Irrespective of data and efficient process design, the bundled payment program probably won’t succeed without the buy-in of clinical staff.


For any alternative payment model, physician leadership and initiative define success, according to Marian Jennings and Seth Edwards, iProtean, now part of Veralon experts. Physicians “embrace the new world of payment and care delivery; they lead the charge and bring their colleagues along with them; and they are actively involved as co-equals and partners with the executives of the health system.” (Financial Risks and Strategic Implications of APMs, iProtean, now part of Veralon, June 2017)




Coming later this week: the advanced Finance Course, Financial Risks & Strategic Implications of APMs, featuring Marian Jennings and Seth Edwards. In this course, Marian and Seth discuss the financial risks of ACOs and bundled payments, the strategic risks of not participating in an alternative payment model, clear trends and the characteristics of organizations that have successfully implemented one or more alternative payment models.



For a complete list of iProtean, now part of Veralon courses, click here.


For more information about iProtean, now part of Veralon, click here.