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Bundled Payment Centers for Medicare and Medicaid Services Dicussion

Bundled Payment Centers for Medicare and Medicaid Services Dicussion

Question Description

I’m working on a health & medical discussion question and need an explanation to help me understand better.

Two classmate responses 125 words each with 3 references each

one: Introduction: Bundled Payment is when the Centers for Medicare and Medicaid Services (CMS) provides reimbursement for a certain diagnosis to acute and post-acute providers who serve the patient. Because of this, the hospitals will dictate if a patient goes home with home healthcare of if they will go to a skilled nursing facility. If they go to a skilled nursing facility, the hospital will determine the length of stay (Spanko, 2019).

Discussion: The advantages of the Bundled Payment Program is the reduction of medical costs. It is cheaper for a patient to go home with home healthcare rather than go into a skilled nursing facility, so by sending patients home or reducing their length of stay in a nursing home, Medicare is saving thousands of dollars. This program also does not trigger for more readmission or emergency room visits; therefore, the hospital will not be penalized (Amin, 2020).

The disadvantage of the Bundled Payment Program is that not every patient is the same. One patient with a hip fracture could heal quicker than another. One could do great with home healthcare, yet another could benefit from staying at a skilled nursing facility (Spanko, 2019).

From a personal standpoint, I work in a skilled nursing facility and I find Bundled patients to be treated unjustly. They come into the facility with a certain diagnosis and because others with that diagnosis only stayed at the facility for 7-14 days, they are required to as well. Not every patient is the same. Some have other conditions and could benefit from staying in a facility and receiving therapy 5 days a week compared to the 2-3 times a week at home.

Conclusion: CMS pays nursing homes using a case-mix adjusted payment system. They have adjusted the guidelines for their systems since the mid-1970’s (Weissert and Weissert, 2019). CMS is always looking for ways to save money. My administrator recently said that she is 80% business, 20% care, while the nurses are 80% care and 20% business. Those responsible for the financial aspects of healthcare will most likely be about business. Therefore, CMS will continue to add and adjust programs to save money.

References

Amin, S. (2020, September 15). What are Medicare Bundled Payments? Retrieved May 20, 2021, from https://www.medicalnewstoday.com/articles/medicare…

Spanko, A. (2019, May 30). ‘Bundling is Not Your FRIEND’: Bundled Payments Remain a Skilled Nursing Threat. Retrieved May 19, 2021, from https://skillednursingnews.com/2019/05/bundling-is…

Weissert, W. G. & Weissert, C. S. (2019). Governing health: The politics of health policy (5th ed.). Baltimore, MD: Johns Hopkins University Press. ISBN- 9781421428949

Two: Introduction: The U.S. health care system is evolving and innovating at a faster rate than at any time since the enactment of Medicare and Medicaid in the mid-1960s (Weissert & Weissert (2019)). Over time, organizations have been able to evaluate options in the format of new organizational structures and reform approaches to ensure continual growth. Similar to Saint Leo’s core value of community, these reform practices and changes in the health care field have taken efforts from all parties and has given provider groups the responsibility of delivering quality care. They foster a spirit of belonging, unity, and interdependence based on mutual trust and respect to create socially responsible environments that challenge professionals to listen, to learn, to change, and to serve (University, S. L. (n.d.)). Accountable Care Organizations, primary care transformation in patient-centered medical homes, and bundled payments all play a part of that responsibility as health care professionals utilize these resources to effectively create reform.

Discussion: There are many different reasons as to why Accountable Care Organizations would be both beneficial and create challenges for health care professionals. These organizations are most beneficial because they coordinate care that helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors (Accountable Care Organizations (ACOs): General Information: CMS Innovation Center. (n.d.)). They consist of a wide variety of medical professionals and facilities ranging from doctors to hospitals who play a role and come together to deliver high quality care to their patients. Although the overall goal of these organizations is to reduce costs through enhanced preventative care and management, they often are faced with challenges that can affect those outcomes. A challenge associated with these organizations is getting everyone on board to achieve such desired reduction of costs. This means that the organizations that impact these costs also have to be willing to share in overall savings which could possibly affect their ability to properly care for patients and provide quality services. There are limits to how much savings can be achieved; however, cutbacks on staff, technology, and other factors would possibly be needed which isn’t possible when you are looking to implement strategies that produce growth for the company.

A transformation in primary care is an essential transition for patient-centered medical homes and should be a focus for medical professionals and physicians. The primary care medical home is accountable for meeting the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care (Defining the PCMH. (n.d.)). A benefit of having these homes is that they are focused on improving outcomes and producing results not volume. Because of this, they are able to implement strategies that respect each patient needs and offer high quality care. Unfortunately, this type of transformation and attention to detail with patient care in these homes comes with its challenges and obstacles. One challenge with this type of care is that since it is relationship-based with an orientation toward the whole person and not community-based, the core functions of primary health care can sometimes be difficult to manage causing physicians to overlook or miss other patients and their specific medical needs. Overall, quality and safety are what is most important for these homes as they are essential to deliver high quality care that addresses patient’s needs.

In addition to the transformation of patient care, reimbursement for services is changing as well in the health care field. Bundled payments are becoming more and more common as physicians begin to realize the benefits of facilitating cost savings under this payment model. A benefit of health care bundled payments is that they expand a provider’s financial accountability to a care episode opposed to a single procedure or visit (RevCycleIntelligence. (2019, March 14)). This makes it easier on the provider to bill for services and ensure they are managing costs. A challenge with this payment model is that it can often confuse the billing process and allow providers to bill for services that may not have been rendered. There is room for unethical behavior to take place and allow for providers to develop inappropriate care strategies for their patients. The journey to finding appropriate care strategies to implement to transform patient care is never-ending and it is the responsibility of providers to ensure they are overcoming any obstacles that occur to achieve patient care goals.

Conclusion: In conclusion, there are many different advantages and challenges in the performance and growth of resources that assist with providing services for patients. Health care is both complex and dynamic and adapting to the changes that occur is part of the transformation. Each of these three essential elements play a big role in the quality of care provided to patients and allow us to see how we as medical professionals can improve these strategies in order to experience continual growth.

Accountable Care Organizations (ACOs): General Information: CMS Innovation Center. (n.d.). Retrieved from https://innovation.cms.gov/innovation-models/aco

Defining the PCMH. (n.d.). Retrieved from https://pcmh.ahrq.gov/page/defining-pcmh

RevCycleIntelligence. (2019, March 14). 3 Challenges Providers Face with Healthcare Bundled Payments. Retrieved from https://revcycleintelligence.com/news/3-challenges-providers-face-with-healthcare-bundled-payments

University, S. L. (n.d.). Mission, Values, Identity. Retrieved from https://www.saintleo.edu/mission-values-identity

Weissert, W. G., & Weissert, C. S. (2019). Governing Health: The Politics of Health Policy (5th ed.). Baltimore, MD: Johns Hopkins University Press.

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