Heart attacks strike about 735,000 people in the U.S. every year. For about 210,000 of them, it's not the first time. The Obama administration, with less than six months on the clock, is betting that changing the way Medicare pays hospitals and physicians to treat them can trim those numbers and save money.
The CMS announced a proposal last week to put three new episodes of care under mandatory experiments with bundled payments, potentially compelling hundreds of additional hospitals into becoming financially accountable for what happens to Medicare patients long after they leave the hospital. It was just one in a series of steps in an effort to move Medicare and the entire industry toward models that pay for the quality of healthcare rather than the quantity of services.
But the nature of the care in the new proposal—treatment for acute myocardial infarction (heart attack), coronary artery bypass grafts, and treatment for hip or femoral fractures—constitutes a bigger ask for the participants, which haven't been chosen yet. And for hospitals with limited experience with bundles, the brisk pace of the transition could pose additional challenges. Nonetheless, many are cheering the aggressive adoption of mandatory bundles because, they say, it gives them a framework to provide better care for patients.
“They are increasing the risk profile for the hospital and for the treating physicians who are falling within the bundled-payment program,” said Dr. James Caillouette, chief strategy officer for the Hoag Orthopedic Institute in Irvine, Calif. “All those involved in healthcare have always wanted the best for their patients. Providers now have a greater amount of skin in the game and risk in the outcome.”
In bundled-payment programs, the payer—in this case, it's Medicare—sets a target price for a medical or surgical episode, like a heart attack or a broken hip. Although it still pays providers on a fee-for-service basis, the total costs are then reconciled with the target amount. Hospitals either pocket or pay back the difference.