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Congress considers bundled payments for Medicare

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While the idea is still in its early stages, Congress is taking a serious look at the notion of paying for an episode of care in some cases rather than permitting providers to bill for separate procedures. While critics of "bundled" payment argue that this approach still has significant flaws, supporters say that it will lead to lower costs and better quality.

The idea is not completely new. In fact, Medicare is already running a pilot project testing such an approach, which could involve paying for, say, several months of cancer treatment or implantation of an artificial hip. 

Under the terms of the pilot, which involves several hospitals, the bundled payment is split between the hospital and physicians.  Participating hospitals had submitted bids on certain procedures for the bundled payments, including heart bypass surgery, and hip and knee implants.

However, there are lots of stakeholders questioning whether bundled payments are a good idea. For one thing, physicians worry that this set-up gives too much control to hospitals. What's more, critics note that to make such a system work, payments would need to be higher for sicker patients, to discourage physicians and hospitals from picking only the healthiest ones. Also, Medicare would have to make sure that providers didn't deny care to increase their profits.

To learn more about this issue:
- read this Kaiser Daily Health Policy Report item

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It is always fascinating to see the various requests to Congress and the things they do. This Congressional session will perhaps be more interesting because of everything included in the stimulus bill and everything else that Congress will have to deal with. I'm curious to see how this particular Congress will handle all of the competing priorities. This issue in particular looks like it will inspire a lot of debate.

The Democrats are touting their first 100 days as the time when they are going to get a tremendous amount accomplished. I hope they do accomplish something significant in the first 100 days. It seemed like the last Congress didn't accomplish much in all of 2008. I saw that the Friends of the U.S. Chamber of Commerce is asking people to give their opinion on the most important thing for Congress to do in their first 100 days. Then they're going to work to get Congress to accomplish what the public actually wants them to do. If you think they should address bundled payments for Medicare, make sure to add your opinion so Congress can know what our priorities are - www.friendsoftheuschamber.com/email/email4.cfm?id=200

The facilities will never pay the private physicians. This will cause a major decrease and delayed payments to the providers.

NOT A GOOD IDEA!!!!!

The Centers for Medicare & Medicaid Services (CMS) recently announced the 5 sites for the Medicare Acute Care Episode demonstration. The demonstration will include 28 cardiac and 9 orthopedic surgical services and procedures, and CMS will make a single payment for both Medicare Part A and B services.

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