Addressing the tendency of fee-for-service to promote more spending requires changing the metrics that motivate clinician behavior away from volume as a primary focus. The DRG system, an early example of bundled payment, represents an attempt to solve the problem by paying hospitals a set amount for each hospitalization. DRG-based reimbursement incentivizes hospitals to keep costs down by eliminating unnecessary services and by shortening length of stay (LOS). Indeed, in the 30 years following the introduction of the DRG system, average hospital LOS nearly halved, dropping from 10.0 days in 1983 to 5.1 days in 20131,2.
CMS Embraces Innovation and Competition
Steve Wiggins with Nick Bluhm and Ryan PardoSeptember 20, 2017
Today, Seema Verma, the Centers for Medicare and Medicaid Services (CMS) Administrator, published a Request for Information seeking feedback on how to lead CMS’s Innovation Center in a new direction. Her statements reflect a belief in competition, consumer empowerment and a willingness to use waivers to enable meaningful innovation.
Remedy in the News
Remedy continues to be a strong advocate for the BPCI program and using bundled payment models as a path to healthcare transformation.>
CMS proposes changes to CJR: 6 key thoughts on what this means for orthopedic bundled payments
Becker's Spine Review | August 18, 2017
Is HHS’ Proposal to Scale Back Mandatory Bundled Payments a Step Back from Value-Based Care? Many Healthcare Experts Say No
Healthcare Informatics | August 18, 2017
Chris Garcia Named CEO of Remedy Partners
Remedy Partners, the nation’s leading bundled payment company, has named Chris Garcia its chief executive officer, effective July 12, 2017. Remedy is well-positioned for accelerated growth as the healthcare industry continues to adopt bundled payments as a core value-based payment strategy.
According to a Proposed Rule released on August 10, Medicare's next iteration of voluntary bundled payments will be an Advanced APM in 2018, opening the door for robust participation. The Proposed Rule, if implemented in January 2018, would cancel the Mandatory Cardiac Episode Payment Models and make participation voluntary in the Comprehensive Care for Joint Replacement model for half of selected Metropolitan Statistical Areas (MSAs) and for low-volume and rural hospitals.
Offering Enables Health Plans, TPAs, Self-Funded Plans and State Medicaid Plans to Administer Episode of Care Benefit Plan Designs
Remedy Partners executives will be featured in three sessions during The Seventh National Bundled Payment Summit, a leading forum on healthcare payment reforms, to be held on June 26- 28, 2017 in Arlington, VA.
Remedy Partners is proud to be a Bronze sponsor of AHIP - America's Health Insurance Plans Institute & Expo 2017 this year. The event takes place in Austin, Texas on June 7 – 9. AHIP is the premier conference for the health insurance industry.
Palliative care improves quality of life by relieving symptoms, providing psycho-social support, and by lowering costs by eliminating unwanted inventions, such as hospital readmissions.1,2 Because bundled payments approach episodes of care with the patient’s goals at the center of all care planning, bundled payments can help make palliative care available to patients by offering incentives that help avoid expensive care that may be at odds with the patient’s wishes. Further, effective January 2016, CMS reimburses physicians for “advance care planning” activities that support palliative care as part of the updated Physician Fee Schedule under two new CPT codes.
Two recent studies demonstrate that the number of elective procedures does not vary significantly in bundled payment programs when compared to controls. Wilson, de Brantes and Conway analyzed1 the Medicare Bundled Payments for Care Improvement initiative to determine if the volume of Lower Joint Replacement (LJR) procedures increased under the model. Their analysis was in response to an editorial3 in the Journal of the American Medical Association that raised questions about elective procedure volume and bundled payments in an accompanying JAMA study.2
ACOs and episode payment models can and do work together. To be most successful, payers need to synchronize the payment models they sponsor for participating providers. To help the Medicare program in this task, the Health Care Transformation Task Force released principles to consider when apportioning responsibility between alternative payment models covering the same patients.
Remedy CEO Carolyn Magill Cites Bundles as a Catalyst for Systemic Change
The spotlight was on bundled payments this week as CMS delayed the mandatory implementation of bundled payment initiatives for cardiac care and the expansion of the Comprehensive Care for Joint Replacement bundled payment pilot project. The delay, which was consistent with HHS Secretary Tom Price’s known objections to mandatory initiatives, allowed proponents of the Bundled Payment for Care Improvement initiative (BPCI) program, like Remedy Partners CEO Carolyn Magill, to reinforce the program’s success to date.
When Secretary Price said "people have coverage, but they don't have care," he underscored his commitment to one of the core values of bundled payments: patient-centered care. Dr. Price believes that “patients and doctors should be in control of healthcare”; which is why he does not support mandatory pilot programs.” He understands that providers need flexibility, not dictations, to accommodate the needs of their patients.