A new national contract could bring hundreds of patients from across the country to St. Vincent Charity Medical Center in Cleveland for bariatric surgery.
The draw? A new and growing payment model that links historically siloed charges into one bundled payment, incentivizing providers to keep costs down, giving insurance companies and patients an expected price tag and potentially improving quality of care.
Bundled payments may be a solution to what Tom Campanella, director of the health care MBA program at Baldwin Wallace University, calls one of the biggest challenges in health care: fragmentation.
A surgery in a hospital can mean several separate charges: one for the surgeon, another for the anesthesiologist, a pathologist or emergency room physician if they're involved, then the rehab, occupational therapy, and on and on.
“The analogy I would use is a balloon,” Campanella said. “You have all these different parts, and even if you squeezed down on one, the other side would pop up from a cost standpoint. So now they're saying let's wrap all of that together in a bundle.”
Bundled payments have an agreed-upon price tag. Any money not spent below that target is savings for the hospital, but overspend and the hospital pays.
Several Northeast Ohio hospitals have been piloting the bundled payment model through the Centers for Medicare and Medicaid Services. As CMS begins to see the benefits of bundled payment, officials expect to see the approach more and more in the commercial industry, such as the contract St. Vincent landed.
Already, third-party vendors to negotiate bundled payment contracts between hospitals and insurers or employers are emerging, Campanella said.
“It's moving like crazy,” he added.
St. Vincent was selected through a national competitive selection as the first hospital in the country to participate in the Pacific Business Group on Health Employers Centers of Excellence Network for bariatric surgery. Through the contract, which went into effect Jan. 1, the hospital will provide weight-loss surgery for large national employers through a bundled payment arrangement.
Dr. David F. Perse, St. Vincent president and CEO, said the contract will help the hospital have a national reach and compete locally in what can sometimes create “an untenable situation for health competition.”
“In our market, the dominance of the big players is keenly felt by us,” he said. “So bundled models, I believe, create opportunity for entities to reach beyond local markets and to perhaps be evaluated more soberly with regard to cost and quality.”