Healthcare organizations need to get ahead of new bundled payment programs coming from the Centers for Medicare & Medicaid Services, Rob Stone, a partner in the Atlanta-based law firm Alston & Bird, says in an interview at Healthcare Informatics.
One proposal, the Comprehensive Care for Joint Replacement Model, would bundle payment and quality measurement for hip and knee replacements through coordination of care from initial hospitalization through all the services required for recovery.
"To the extent that there are gaps in care coordination and integration and handling of data, it's going to make it more difficult to successfully navigate these bundled-payment programs, so getting ahead of that … thinking through the infrastructure issues, as well as thinking through the HIPAA and data security issues, will position people better," he says.
There will be some new metrics in these programs, with quality metrics just one aspect, he says. CMS will provide data to hospitals about who's providing services, what services are being provided, and what kinds of patients are receiving care in the program to help organizations in their planning to meet the program goals.
There will be data that hospitals send to CMS, with some discussion about moving the quality threshold higher to continue to receive payment, he adds.
In addition, Stone says, the least-defined set of data deals with a concept called care redesign, which is about sharing data among providers as well as for use of data for new tools used for decision-making.
The Comprehensive Care of Joint Replacement payment model is to be rolled out among hospitals in in 75 geographic areas. The focus on joint replacement care stems from wide variation in costs across the country. The price for knee and hip replacements--the two fastest-growing medical treatments in the country--differ by more than $20,000 from one place to another.
CMS also noted in announcing the initiative that the rate of complications like infections or implant failures after surgery can be more than three times higher at some facilities than others.
However, FierceHealthFinance's Ron Shinkman contends that bundled payments won't curb the volume of procedures being done.
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