ASSIGNMENT | Bundled Payments

After reading about bundle payments, discuss your thoughts, concerns, and experiences.  How is this impacting nursing?  Simply, are bundle payments a boom or a bust?

Passed in October, 2011 and implemented in 2013, the Bundled Payment Initiative gave providers flexibility to work together to coordinate care for patients over the course of a single episode of an illness.  There are four broadly defined models of bundled care:  three of these models involve retrospective payment and one is prospective.  In the retrospective payment models, Center for Medicare/Medicaid Services (CMS) and providers set a target payment amount for a defined episode of care.  This target amount would reflect a discount in total costs for a similar episode of care as determined from historical data.  Participants then would be paid for their service under the Original Medicare FFS system but at a negotiated discount.  Models 2 and 3 may include clinical laboratory services and durable medical equipment (CMS, 2016)

The prospective payment model differs in that CMS makes a single, prospectively determined bundled payment to a hospital that would encompass all services furnished during the inpatient stay by the hospital, physicians, and other practitioners.  Physicians and other practitioners would be paid by the hospital out of the bundled payment.  

SAMPLE SOLUTION

The Bundled Payments for Care Improvement (BCPI)
The Bundled Payments for Care Improvement (BCPI) was instituted in 2013, with the primary aim of holding healthcare providers to account for the quality of care and cost therefore encouraging and rewarding the value of healthcare (“Bundled Payments for Care Improvement”, n.d.). These payment initiatives, based on the value of care as well as improvements to the older Medicaid and Medicare programs, are still experimental and have yet to prove their full implications. Bundled payments have so far shown some advantages such as providing incentives for providers that minimize costs including the prevention of avoidable complications. They also promote collaboration among various providers…