Could bundled payments be the key to keeping struggling hospitals healthy?
The American Hospital Association seems to think so and it's planning on lobbying for several legislative changes including loosening anti-kickback laws to allow financial agreements between hospitals and other healthcare providers.
In a 56-page report created by an AHA task force meant to help cash-strapped hospitals in both rural and urban areas stay afloat, the organization suggests that adopting bundled payments for individual episodes of treatment could encourage hospitals to contain growth and concentrate resources on services that improve quality and lower costs.
Other ideas include addressing the social determinants of health, such as screening patients to identify any unmet social needs, reducing inpatient bed capacity to a level that more closely reflects the needs of a community, enhancing outpatient and primary-care services and embracing telemedicine.
“The Task Force has provided a menu of creative options … without such efforts, in the current environment, health care in the nation's least well-served communities may seriously deteriorate,” Bruce Vladeck, a former CMS administrator and senior adviser at Nexera, said in a statement. The AHA estimates 1 out of 3 hospitals is fighting to survive.
The task force is made up of 29 leaders from hospitals and health systems and state hospital association CEOs. They heard from policymakers and conducted surveys of other hospital and community leaders to obtain their results.
Bundled-payment initiatives, which are helping to reshape the healthcare landscape in the broader push to wring more value from healthcare dollars, was near the top of the suggestions.
Since 2010, the CMS has rolled out and subsequently expanded its voluntary Bundled Payments for Care Improvement Initiative to 6,000 participants and 48 conditions. The CMS also implemented its mandatory Comprehensive Care for Joint Replacement, and, next year, is poised to expand that, too.
But hospitals have have been slow to jump onboard. To date, 31% of hospitals have adopted bundles in some form, as have 20% of employers, a recent survey by the consulting firm PricewaterhouseCoopers found 52% of hospitals were interested in adopting bundles but had yet to do so.
The AHA reported that making many of the ideas in the report a reality will require additional rulemaking or legislation. It suggests modifying new payment methods, expanding federal demonstrations, changing existing Medicare payment rules that prevent providers from placing patients in the most appropriate care setting and expanding coverage of telehealth.
“Now is the point in time that providers need much more flexibility in terms of partnerships and how we get reimbursed for care,” said Karen Teitelbaum, a task force member and president and CEO of Sinai Health System in Illinois.
James Skogsbergh, AHA task force member and president and CEO of Advocate Health Care, said the group will aggressively lobby federal and state legislators for these changes.
The AHA feels that President-elect Donald Trump's administration, including HHS secretary nominee Rep. Tom Price (R-Ga.), who has frontline experience as both a physician and a lawmaker, will be open to changes.