Major changes are coming to the way seniors receive certain common Medicare services.
And while the changes are designed to improve care and eliminate duplicative costs, consumers need to keep a close eye on how they unfold, advocates say.
In a proposed rule more than 900 pages long and set for publication in the Federal Register in early August, the Centers for Medicare & Medicaid Services lays out a framework for paying health care providers to better coordinate certain medical procedures, such as joint replacements and cardiac care, with the aim of improving patient outcomes.
They'll get a set fee, or a bundled payment, to care for patients. If they meet quality and performance measures, they'll earn higher federal reimbursement. If they fail, they'll earn less. The federal program will begin a five-year test of the new payment models next year in randomly selected geographic markets. It’s expected to save the program $170 million over the five years as some providers lose reimbursements because of poor performance.
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“Now is a great time to be talking to your doctor about how your care is being delivered now and how that might change in the future,” said Stacy Sanders, the federal policy director for the Medicare Rights Center.
Bundled payments are only one part of the overall push in health care toward more value-based pay. Some precursor test programs are already underway, and Sanders said patients should ask questions of their physicians about what types of arrangements their practices are participating in and how outcomes are being measured, as well as how that might change in the future.
“On the one hand, all these payment reform systems offer the promise of higher-value care and better coordination at lower cost but we need to be vigilant about how incentives might encourage providers to potentially skimp on care,” said David Lipschutz, the managing attorney for the Center for Medicare Advocacy. “For example, with bundled payment models, who holds the bundle determines a lot of the outcome. Say you have a hospital holding the payment for a post-acute care episode. Are there incentives to not pay for someone who could really use skilled nursing and instead push them to outpatient care or home health?”
There are quality measures built into these programs to address that concern, experts noted, but there are a few things patients should do:
It’s important to fill out those pesky patient satisfaction surveys regardless of whether you had a good or bad health care experience, notes Josh Seidman, a senior vice president at Avalere Health and the head of the firm’s Center for Payment & Delivery Innovation.
“It’s very important that patients express their candid opinion about their experience of care because that is how they are going to make sure the concerns won’t happen again,” he said. Likewise, praising excellent care creates a positive reinforcement mechanism that can incentivize physicians in a good way, he said.
While these measures are designed to improve patient outcomes, there’s always a danger of “teaching to the test,” Lipschutz said, or organizations finding ways to artificially create the outcomes called for in the rules.
“You always have to stay vigilant about discussing why certain plans and procedures are being recommended,” he said. “This is always difficult when you’re in the middle of a health situation, but always ask” why a certain course of action is in your best interest, he said.
Understand how your local medical community works. Do you see a physician who works in a small private practice, or one employed by a large hospital? These arrangements can make a difference in whether you'll be part of these bundled payment arrangement trials or other value-based payment programs in the future, for better or worse.
On the plus side, the new incentives should substantially reduce the confusion and hand-off issues that often accompany a procedure like a hip replacement, said Blair Childs, the senior vice president of public affairs for Premier Inc., an alliance of 3,600 hospitals and other providers that focuses on health care innovation.
“You hear a lot of talk about patients being lost in the handoffs between physicians and post-acute care facilities and the terrible things than happen in these handoffs. There’s never been an incentive to ensure the patient is managed really well through these transitions because providers are all in silos. Now we’re talking about designing care much more centered around the patient,” he said.