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Many providers have found success with bundled payments since the 2011 release of the Bundled Payments for Care Improvement (BPCI) by the Centers for Medicare & Medicaid Services (CMS)—some more than others. While bundled payments overall have been proven to improve quality and lower costs, specialists have an opportunity to maximize the savings and outcomes. As the industry prepares for the next generation of BPCI, it is a great time for specialists to consider managing bundled payment programs.
Specialists are well-positioned for leadership and ownership of bundled payments. Under the first BPCI model, both physicians and hospitals saw success using bundles: lower costs, decreased length of stay, and decline in skilled nursing facility utilization. However, across the board, specialists saw greater success in these measures. In fact, specialty practices that partnered with Archway saved at least $2,000 per case. In comparison, hospitals owning the bundles lowered their costs at an average of $864 per case, according to a BPCI annual report prepared by the Lewin Group.
The reasons why specialists are able to outperform hospitals on bundles are due to the nature of the patient-physician relationship. Specialists truly know the patient beyond what’s documented in their medical records. They know the nuances of the patient’s case like their personalities, support available to them post-op, and likelihood of adherence to post-discharge medication and care instructions. As the performers of surgery, they also intricately understand the nuances of the procedure, and are able to identify pockets of overutilization before, during and after the operation.
Given that hospitals are larger, and typically manage more patients than physicians, it can be tough for them to be nimble and provide personalized service in large quantities. Additionally, conflicts of interest that physicians do not typically have can come into play. Many hospital systems own skilled nursing facilities or home health agencies, and may be inclined to refer patients to these services, even when it is not necessary. Hospital administrators are aware of their vulnerabilities and have systems in place to counteract them, but data shows that when it comes to bundles, physician-owned episodes produce better results.
At Archway, we champion specialists. We believe they are optimal partners to own the bundle and we are solely focused on helping them succeed in bundled payments. We partner with specialists to help them evaluate, design, and manage bundled payment programs.
In a free, half-hour consultation, we can help specialists who want to own their bundles learn what the next generation of BPCI will look like, and even share a provider-specific Bundled Payment Scorecard that reveals potential savings.
To learn more, please contact our team at firstname.lastname@example.org.