Medicare, Meet Bundled Care: We’re Living Proof it Works

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What is Bundled Care?

Health services packaged together for one upfront price to provide a patient a comprehensive episode of care, including all necessary services accompanying a procedure.

The Centers for Medicare and Medicaid Services (CMS) announced a revolutionary new bundled payment program last week. Starting in July 2017, patients admitted to hospitals in 98 metro areas for heart attacks or coronary bypass can look forward to a bundled continuum of care that tracks their progress over a full 90 days. This new cardiac program will mirror an expansion of an existing CMS foray into bundled episodes of care for hip replacements and surgeries. Hospitals and doctors who are struggling with how to adapt to the new Medicare rules – with a definite deadline looming – will be relieved to know that MDsave and its hospital partners have been successfully bundling payments for episodes of care since 2012 – delivering price transparency and billing efficiencies for doctors and patients alike. That same patented technology can be made available to providers and hospitals outside of MDsave’s public healthcare marketplace to support virtually any episodic care bundle, including those mandated by the CMS.

“Bundling healthcare is a relatively new idea,” according to MDsave co-founder and CEO Paul Ketchel. “Traditionally, healthcare employs fee-for-service line-item billing. Every provider contributing to a service invoices separately and collects payment from the patient in their own way. MDsave has developed proprietary software to allow providers to pre-build healthcare bundles based on a pre-set negotiated price that they will receive for the comprehensive set of procedures in that bundle. The patient only pays one bill, and the providers don’t have to spend the time and energy tracking down payment.”

What Does Bundled Care Mean for Patients?

Medicare patients entering the hospital for bundled procedures can expect cooperation and coordination between all of the providers involved in their care, from the surgeon to the physical therapist, because they partner together upfront to provide all needed care for each patient and each unique case, at one set price. There is no financial incentive for providers to send patients back for expensive hospitalizations when more cost-effective and less intensive therapies will serve just as well.  Because all care providers coordinate the components and comprehensive price for each episode of care upfront, each provider is motivated to take an active role in patient follow-up. The increased attention to post-acute care can improve patient outcomes and reduce the chance of return trips to the hospital.

What Does Bundled Care Mean for Doctors?

By acting as a coordinated team, rather than passing the patient from one provider to the next, doctors and other providers will be rewarded for sticking with a patient throughout the 90-day recovery period. Providers who can manage heart attack, coronary bypass, and hip surgery patients with outpatient therapies and more cost-effective measures will be rewarded with bonuses, while those who rely on measures like re-hospitalization may end up owing Medicare due to lack of follow-up. More comprehensive care means better outcomes and lower costs for both hospital and patient, which is a win-win for everyone.

We Know it Works, Because We Do it Every Day

MDsave has been offering bundled procedures and payments to self-pay patients since 2012. We see first-hand the value of bundled payments to both our patients and physician partners.

Through our bundled episodes of care, our customers know their comprehensive price upfront, and our physicians can offer competitive prices because we can guarantee quick and reliable payment within a week. With bundled payments, both patient and all involved providers know what to expect from the program of care, who else will be involved, and how much it will cost – no surprises.

The Secret is the Software

One size does NOT fit all when it comes to medicine. Medicare will be setting prices for the cardiac and orthopedic care bundles based on historical cost data, regional data, and complexity of the case. MDsave’s patented software allows providers to create bundles by cross-referencing the databases for the Medicare diagnosis codes, international disease codes, and geographical variances, to ensure that pricing is fair for the facility and complexity of the case. Because our software uses Medicare data, we know that the care bundles we offer are in line with the CMS mandates and updates, and that we will stay on the leading edge of value-based care.

Bundles Mean Patient-Centered Care

The goal of every procedure is to get the patient the care they need, for the best quality and lowest cost possible, without the need for hospital readmission. Bundling episodes of care makes that goal the responsibility of an entire team, all working together on their patient’s behalf. As CMS expands bundled care programs for cardiac care and hip surgery, MDsave provides a proven technology to support bundled care episodes across providers to deliver the suite of services patients need everyday – from school physicals and lab work to surgery and physical therapy.

 

About MDsave

MDsave contracts directly with trusted  providers to offer pre-negotiated savings to patients. Compare local prices, save money, and buy your procedure  — all in one place. From imaging to cardiac assessments, view our complete list of services and participating physicians. Learn more.

 

Sources:

http://www.healthcare-informatics.com/article/hhs-announces-new-mandatory-bundled-payment-models-cardiac-care-focusing-mi-and-cabg

http://www.modernhealthcare.com/article/20160726/NEWS/160729924

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