Doc leadership, engagement key to bundled payment success

Three health system leaders shared their experiences working with CMS to test one of four models of payments based on episodes of care at an executive briefing today at the American Hospital Associations annual meeting in Washington, D.C. 

The Centers for Medicare & Medicaid Services launched the new bundled payment initiative in January. 

Despite participating in different bundled payment models, two themes ran through their discussions: identifying and engaging clinical leaders and physicians--both of which are critical success factors.

A model 2 provider, Nashville's Vanderbilt University Medical Center emphasizes bundled payment teams headed by physician co-champions.

"You need physician leaders to convince the others what's going on, provide their clinical knowledge, but also really be a champion for the project and say 'this is really going to work and here's why I believe in it,'" Edward Marx, Vanderbilt's director of Strategic Analytics told the AHA audience.

By making clinicians leaders on bundled payment projects, they can engage peers and help hospitals overcome initial skepticism and resistance from physicians.

The other panelists agreed, expressing their concerns for ensuring physician buy-in for bundling payments, especially given their facilities are located in markets largely dominated by independent doctors.

"The physician-to-physician encounter is a lot better than us as administrators going to these physicians saying 'help on these costs,'" said Pat Carrier, president and CEO of Christus Santa Rosa Health System in San Antonio, Texas.

Following bundled payment model 4, Christus Santa Rosa Health System aims to foster collaboration among independent physicians and engage physicians in the process. With that in mind, the health system held education sessions and lectures for doctors, as well as established a physician advisory committee to help work on process change and develop metrics, Carrier noted.

In addition to the hospital-physician relationship, bundled payments require strong connections with other community organizations, according to Ray Montgomery, president and CEO of White County Medical Center in Searcy, Ark. "You don't want to be caught there not having relationships," he warned.

Montgomery recommended hospitals look at area nursing homes and skilled nursing facilities and begin having discussions about bundled payment opportunities.

Hospitals must build these relationships and networks throughout the process, he said, adding that not only are hospitals feeling the pressure to improve efficiency and lower costs, but so are doctors, nursing homes and SNFs--signaling likely cooperation.

To learn more:
- here's the AHA meeting info