My earlier post cited CMS’ foreshadowing of more demonstration projects and a “correction” to the current payment system. I am very pleased to report an excellent (albeit self-serving) white paper by Prometheus (website under construction) that is proverbial “music to the choir” of EIM subscribers and fans of this blog. Reportedly, a team of experts in health care economics, law, policy, plan operations, and performance measurement met over a 20 month period to design these innovation.
Actually, their proposed payment mechanisms (case rates and global fees) are not the innovations but the implementation of paying claims based on certain facets are novel. They include:
1. Basis for case rates is EBP guidelines and includes adjustment for patient severity.
2. clinical integration around the care of the whole patient.
3. Accommodation of a wide variety of providers (PT not specifically mentioned but implied).
They report to build an operational infrastructure that will have payment systems perform the following tasks:
-establishing severity-adjusted Evidence-based Case Rate (ECRs)
-determine the appropriate allocation of those case rates across different types of providers treating the same patient
-track the performance of all providers caring for the patient covered by the ECR
-reconcile all payments to reward good performance
-create a scorecard to report and pay for quality and efficiency (isn’t that what CMS is calming to do?)
One of Prometheus’ beliefs is to hold providers accountable for efficient use of resources but free them to manage those resources in any way they see fit which removes current artificial barriers to innovate. In my opinion, this is critical and liberating as rules and regulations get us away from worrying about coding, 8 minute rules, support personnel, etc. and allows us to do what is best for the patient.
Consider me an early and big fan of Prometheus’ philosophy thus far and I wish them well. You have to love a new company that has gone to this much R&D and whose letterhead (at the bottom) spells out that Prometheus is really an acronym (and I thought it was the greek god of evidence and founder of health care festivus)!! It stands for Provider payment Reform for Outcomes Margins Evidence Transparency Hassle-reduction Excellence Understandability and Sustainability.
I hope they didn’t engage CMS to do their press release.
Exciting to see evidence at the forefront. Thoughts?
Larry