Voluntary Bundles Are Going to Be One Of Many Valuable Tools
With all the rhetoric in Congress about repealing and replacing The Affordable Care Act, it can often get lost in the shuffle that leadership remains committed to value-based care.
For example, while mandatory healthcare bundles seem to be dead – healthcare professionals are actively anticipating the announcement of voluntary bundles very soon.
When the Centers for Medicare and Medicaid Services (CMS) proposed canceling plans to expand its mandatory Bundled Payment Care Initiative (BPCI) program and roll back mandatory participation in the Comprehensive Care for Joint Replacement (CJR) program, it was not exactly a huge surprise. Tom Price, who was the Health and Human Services Chairman at the time of the announcement, had publically stated his disapproval of mandatory bundles.
Yet, studies have shown that bundles work, specifically for conditions where care can be (somewhat) standardized. For example, The Cleveland Clinic reviewed its participation in the CJR and found:
- The average length of hospital stay was reduced from 3.4 days to between 2.67 and 3.01 days each quarter.
- 30-day readmissions decreased from five percent to between 1.6 percent and 2.7 percent each quarter.
- Discharge to home (with and without home health care) increased from 39 percent to a quarterly range of 68 percent to 75 percent.
- Patients who gave their hospital a nine or 10 rating increased from a baseline of 74 percent to between 78 percent and 88 percent each quarter.
Other studies have shown similar success. So, why is CMS scaling back mandatory bundles?
“Tom Price stated that he was overall against the idea of mandatory bundles,” said Saqib Akhter, CEO of Post-Acute Analytics, a company that helps health systems and providers auto monitor their patients in real time outside their four walls.
“However, the way we at Post Acute Analytics look at it, CMS has been clear on Total Quality and Cost of patient care. Healthcare providers need to view care from a total-cost-of-care perspective and total-patient-outcomes perspective. That is not voluntary and is, frankly, mandatory through some means, whether it’s value-based purchasing, MACRA, bundles, an ACO arrangement, a Medicare Advantage program, or capitated contracts,” said Akhter.
“We believe the view of CMS is: We’re not going to mandate bundles; however, we are going to mandate that you need to impact total quality and cost of care – and you can do that however you want to.”
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This is born out by a recent announcement that CMS is redesigning its Innovation Center to give providers greater flexibility in payment models.
“Providers need the freedom to design and offer new approaches to delivering care,” said CMS Administrator Seema Verma in an op-ed published in The Wall Street Journal. “We will move away from the assumption that Washington can engineer a more efficient healthcare system from afar – that we should specify the processes healthcare providers are required to follow.”
This new direction is a great indication that healthcare providers are being empowered to choose the direction of their value-based care.
“I think it is clear right now that bundles make sense for a certain patient population – those with conditions that can be isolated and where the start and end of care an be measured. That’s where bundles make sense,” said Akhter.
“The physicians we’ve spoken with like bundles because they get to focus on delivering comprehensive, holistic care to patients, while also participating in the savings generated from better patient management.
“Additionally, the opportunity to make money around bundles can help providers fund the infrastructure to manage other populations of patients through other value-based models, such as capitated contracts, Medicare advantage, ACO, and other payment models for those high-risk patient populations.”
While it appears that providers are being given more freedom in regards to their value-based care, this can also be a double-edged sword. Providers that make an incorrect choice are still going to face MACRA penalties, which could be very extensive.
“That’s where a solution like Post Acute Analytics can really benefit providers,” said Akhter.
“We can advise on the best processes and insights that are available in real-time to make sure that patient goals with quality and cost are achieved. Through Anna, Post Acute Analytics’ technology platform, providers are able to see – in real time – patients total cost of care, how they’re trending, whether they’re in the black or the red as it relates to each patient, patient outcome, high-risk triggers, and where they need help so physicians can intervene in real time.
“The outcome of all of that is better patient care at lower costs.”