Experts say bundled models can have major success, but participation is key
- Bundled payment models can be successful in improving patient care, but mandatory participation is vital to seeing positive results, a panel of experts said Thursday at the U.S. News & World Report Healthcare of Tomorrow conference.
- Tim Gronniger, nonresident fellow at The Brookings Institution, said that while bundled models are popular among lawmakers and have bipartisan support, there is currently no push in Congress to extend the model through the CMS.
- Health systems implementing bundled models should work one-on-one with physicians to explain the transition and the changes it will require. “You’ve really got to keep your sense of humor as you walk through these changes,” said Tamra Minnier, chief quality officer at UPMC. “Meet them where they are.”
Systems like UPMC are where bundled payment models will see growth and refinement, as the CMS has moved away from mandatory participation and there is no appetite in Congress to push for payment reform in healthcare.
“There doesn’t appear to be any realistic path of Congress picking it up in next four years,” Gronniger said. He said the industry should no longer look to the CMS to push providers to participate in alternative payment models. “This conversation makes me a little bit sad because I think the prospects for large-scale adoption of bundled payments in Medicare are really poor,” he said.
Those providers, payers and employers who work together to create bundles will see many hurdles, but the effort can pay off literally, as well as in terms of improved care quality.
Minnier said UPMC’s bundled payment models have “been an incredible success,” and the system has performed well enough to get a shared savings check from the CMS. UPMC is putting savings back into the program to continue improvements.
Skilled nursing facilities the system approached were all in for the new payment models, but that may have been largely because of the volume UPMC provides them and their thin margins, she said.
Complication rates and readmission rates for procedures in the bundled models have dropped, while post operation scores have increased, Minnier said. “Patients are actually experiencing the transformational change of less pain more mobility,” she said. “That, to me, is obviously the ultimate outcome.”
Minnier said she attributes much of UPMC’s success with bundled payments to the decision to make participation among physicians mandatory. Gronniger said that mandatory participation on a broader scale is also necessary. The CMS under the current administration is moving toward voluntary programs, but without a buy in from providers who aren't as sure of their success, there won’t be true systemic change, he said.
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