How to manage Orthopedic Bundled Payments?

1
(No Transcript)
2
How to manage Orthopedic Bundled Payments?
In a bundled payments model, providers and/or
healthcare organizations receive a single payment
for all the services delivered during an episode
of care. When it comes to Orthopedic Bundled
Payments, these models are becoming more
sophisticated and standardized with the help of
analytic insights based on collected data from
surgeons. CMS has made numerous changes to the
Bundled Payments for Care Improvement Advanced
program for 2021 that will have a significant
impact on participants where these participants
are no longer able to select individual episode
types, such as lower extremity, upper extremity,
or spinal fusion. Orthopedic bundled payments
are rising due to various benefits such as lower
cost, structure, specialist engagement, improved
quality, and attainment of organizational goals.
Moreover, Orthopedics is the most important
service line for most hospitals, and joints are
the mainstream of revenue generation for
healthcare providers. Various lucrative benefits
attracted physicians to participate in the
bundled payments program however, you should know
its management to avoid various challenges like
withhold care from those who require more
resources than the bundle allows, such as those
from a lower socioeconomic status.
3
How to manage Orthopedic Bundled Payments?
Helpful Recommendations for Managing
Orthopedic Bundled Payments Identify
opportunities to reduce patients risk before
surgery The hospital estimated financial risk
for complications and mainly for those that lead
to increased post-acute charges under bundled
payments. Orthopedic surgeons should direct
preoperatively risk assessment tools to identify
opportunities to reduce patients risk before
surgery by helping patients control their
diabetes or by treating pre-existing
Staphylococcus aureus colonization.
4
How to manage Orthopedic Bundled Payments?
Build a robust data system Even after months of
service delivery, the federal government
reconciles episode costs and payments
retrospectively hence providers must carefully
track utilization and expenses in real-time to
manage an episode of care. A robust data system
enables hospitals to respond proactively to
issues that could lead to a poor outcome and/or
increased costs. The established data systems
can help to capture the cost of all aspects of
care, including pre-admission testing, implants,
or any other materials used during the procedure,
the inpatient stay, services provided during the
90 days after the hospital stay, and any
stakeholder payments. Optimizing care
episodes You can optimize care episodes with the
help of cost and outcome variations across an
institution as variation analysis can identify
and reduce unnecessary waste. Data often show no
correlation between high costs and superior
patient outcomes and providers who are outliers
in terms of episode costs can often be persuaded
to adopt more efficient practice patterns. Both
efforts help to control costs which is an
important discipline under bundled payments.
5
How to manage Orthopedic Bundled Payments?
Ensure quality measures Cost control is an
important discipline of bundled payments.
However, quality measures are also an essential
component of these programs. Three principal
quality measures from CMS are the hospital-level
risk-standardized complication rate, Hospital
Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) survey results, and
patient-reported outcomes. Hence to perform well
under bundled payments, hospitals must work to
optimize care quality and patient
outcomes. Stakeholder management If you want to
be successful in orthopedic bundled payments then
you need careful management of various
stakeholders like physicians, nurses, ancillary
staff, and post-acute providers. The alignment of
various stakeholders must be the primary
objective of Hospital administrators
and orthopedic leaders to achieve the mission and
goals of the bundled payment program. Moreover,
interdisciplinary leadership teams are organizing
clinical units which help to offer coordinated
services across the episode of care.
6
How to manage Orthopedic Bundled Payments?
Finally, you need to understand that CMS has been
clear that bundles are here to stay, and CMS has
already signaled for a much broader and
all-encompassing mandatory bundled payment
program. Hence management of these bundled
payments is also crucial. Looking to streamline
your orthopedic bundled payments? Contact us
today at info_at_medicalbillersandcoders.com or
call 888-357-3226 for expert billing solutions.