In yet another shotgun approach to saving healthcare, USA Today ran a front page article “Can ‘bundled’ payments help slash health costs”.
It detailed a 3 year medicare demonstration project in Tulsa, Ok which started this past May whereby CMS will pay a single payment for all the hospital and doctor care for heart and joint procedures rather than the traditional separate fees for providers and facilities. A picture of a patient receiving PT at one of the “approved” PT centers participating in the “bundling” program is shown. The article points out pluses and minuses of this concept.
While no doubt a bundled system for certain items in medical care makes great sense and we have frequently documented in this blog the problem of “overtreatment” and the article aptly points out the collective efforts to eliminate waste in the surgical process (e.g. too many surgical drapes) as well as care that is not based on good evidence. However, the notion of transferring administration of care and payments to a hospital makes about as much sense as having the vehicle license bureau co-exist as a dayspa.
It is one thing for a hospital system to be forced with DRG’s and other bundled payments by a payor but that is significantly different than putting the hospital in a system to negotiate with implant companies, contract with the most efficient providers, and then transact claims and payments to providers. Managing cost and managing care are as different as selling license plates and performing a facial. At the end of the day, you would end up with a significant conflict of interest-all services would be rendered at a hospital which is the most costly cog in the system or there would be the “limbo” contracting of providers and services for rates probably half of what medicare currently reimburses. The article aptly points this out to a certain extent by mentioning the hi cost for the hospital to purchase a claims system and to invest in advertising and promotion. For those keeping track, it is a Physician Hospital Organization (PHO) of a slightly different color and we all know how successful and sustainable those were in curbing healthcare costs in the 90’s.
As a provider, I can think of several times when a common sense thing like “bundled” payment (or per visit) was tried in physical therapy only to suffer from the “system” problem-payor IT systems can’t handle and the administrative nightmares forced abandoning the “good idea”. While systems improve and change and I am aware of many per diem contracts (most of them pay lousy in my experience), this is altogether different than a procedure that involves many providers and coordinating of services.
As we have pointed out on this blog several times, there is no quick fix or innovation of healthcare. When you hear of the “one great idea” look well beneath the hood. A complex system like healthcare cannot be fixed by simple solutions.
Thoughts?
