Cleveland Clinic exec: Bundled payments require close clinical attention

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Success in the bundled payment environment requires extensive preparation and planning before a patient enters a hospital--even when the organization is powerful, prestigious or well-managed.

Bundled payment programs are being deployed in greater numbers. The Centers for Medicare & Medicaid Services has launched a large-scale initiative focused on joint replacements. And some studies have suggested bundled payments can cut the cost of post-discharge care.

Cleveland Clinic had that experience, according to NEJM Catalyst, which interviewed Monica Deadwiler, the healthcare system's senior director of financial product innovation. While physician leadership has been among the most important keys for operational success in such an environment, Deadwiler said extensive preparation focused on individual patients matters as well.

“We realized was that it was really important to help the patient navigate post-discharge, and that in order to successfully achieve that, the planning needed to start far in advance of that patient being admitted to the hospital. It really needed to start at the beginning when they were indicated that they were a candidate for surgery,” Deadwiler told NEJM Catalyst.

The use of risk managers to assess patients prior to a procedure and ascertain their risk for readmission was also critical, she added.

Despite of the success of the program so far, Deadwiler told the publication she does not believe bundled payments should be a one-size-fits-all solution. While it may work well for specialty care, like total knee and hip replacements, it doesn't work well for chronic diseases like diabetes, she said.