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CMS Unveils 4 Bundled Payment Models

Cheryl Clark, for HealthLeaders Media, February 4, 2013

From Edison, NJ to San Bernardino, CA, some hospitals and doctors will soon embrace big financial risks with four federal bundled payment models that allow them to reap some avoided Medicare costs, even though it may mean absorbing excess patients' expenses up to 90 days after they leave acute care settings.

"For doctors who have never managed care before, who stay independent, and have done a lot of fee for service medicine, this is a way to start changing the culture, which is what we need to do because the old dis-aggregated, specialty driven fee-for-service system is what's bankrupting this country," says Steven Barron, President of 463-bed St. Bernardine Medical Center in San Bernardino, CA.

William Oser, chief medical director of 498-bed JFK Medical Center in Edison, NJ, says that by working with doctors to be more efficient, and streamlining hospital services, for example adding certain test procedures on weekends, length of stay and therefore costs can be reduced.

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"What we found is that if we are thoughtful, and actually in some cases provide more care but on a more timely basis, it's better for the patients and at the end, more efficient and less expensive."

Last week the Centers for Medicare & Medicaid Services officially rolled out these four models of bundled payments prescribed by the 2010 healthcare reform law. They are intended to drive efficiency in the care of expensive Medicare patients. The models' designs vary in how they bundle episodes of care, and may even vary with each hospital's negotiated contract.

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2 comments on "CMS Unveils 4 Bundled Payment Models"


Peter Reisman (3/21/2013 at 7:40 PM)
It sounds simple, but these models will require substantial IT, medical records, accounting and management coordination support on the provider side, and claims processing, medical review, policy review and fraud control oversight on the government side. I have my doubts about the government's ability to manage them adequately.

Beryel Cox (2/5/2013 at 9:23 AM)
What needs to be done is the hiring of Health Information Management major at the partner level. Move beyond the old paradigm that the HIM graduate is well trained in Medical Record. The modern HIM Associate and Bachelor degree programs around this country and Canada are teaching us Health care systems. There is becoming a large pool of well trained HIM graduates that need the opportunity to do their PPE and find that first foot in the door. What other training program has as many classes in CMS payment models than the AHIMA approved programs. We are trained in understanding health care economics from the very first class, until we graduate. We understand the complex systems of modern health care. The HIM graduates are the rescue preservers for the sinking healthcare revenue ship. Understand what we study, understand how grueling the course of study is for a HIM major and then contact your local Community College and four-year college an hire from a AHIMA approved program. We all need employment!