Bundle hospital and specialists fees

[RxBoy]

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Although there were a lot of vague medicare reforms in the new stimulus bill.. one specific reform will def. involve anesthesiologists:

Bundle hospital and physician fees

"When you pay doctors for every procedure they do, there's an incentive for unnecessary treatments. There's a financial reward for fixing problems that better care might have prevented. And there's no incentive for doctors to prevent complications. On the other hand, few people want to go back to capitation — paying a single, annual fee for all of a patient's care. That's been criticized for leading to undertreatment. So a lot of powerful people are looking toward a middle road: Paying a single, bundled fee for an "episode of care" such as a hip implant or a few months of treatment for cancer or a chronic disease."

"The Centers for Medicare & Medicaid Services (CMS) recently announced the 5 sites for its Medicare Acute Care Episode demonstration. The demonstration will include 28 cardiac and 9 orthopedic inpatient surgical services and procedures and CMS will make a single payment for both Medicare Part A and B services."

"So for hip replacement surgery, it's not one fee for the pre-op X-rays, and one fee for the anesthesia, and one fee for the surgery, and one fee for the hospital stay, and a regular set of fees for the rehabilitation process – it's one fee for the entire health care "episode"."

This reform will divide and conquer doctors/hospitals by basically making us all fight for the scrapes of the bundle so insurance companies won't have to.

Any thoughts how this will impact Anesthesia? One thought I had would be surgeons+hospitals might cut us high and dry by solely using CRNAs so that they can each take a bigger chunk. This of course is just a thought...

 

[coprolalia]

Any thoughts how this will impact Anesthesia? One thought I had would be surgeons+hospitals might cut us high and dry by solely using CRNAs so that they can each take a bigger chunk. This of course is just a thought...

This is a pretty insightful thought, and not an unlikely scenario. Administrators will quickly figure out that they can make more money by completely cutting "us" out of the equation.

-copro

 

[jwk]

This is a pretty insightful thought, and not an unlikely scenario. Administrators will quickly figure out that they can make more money by completely cutting "us" out of the equation.

-copro

Big step in the wrong direction if the hospital is given that type of control.

 

[CuriousKat]

In this new model of bundled payments, one important bargaining chip a physician/group of physicians needs to have is simple:

"Ownership" of the patient

Obviously, specialities that will be affected most negatively would be anesthesiology, radiology, pathology etc.

If a hospital receives $10,000 for the admission/ancillary testing/hospital care/surgery/rehab for surgery X, how will they divide the payments? Clinicians can control whether they take their patient to hospital A or B and may have some leverage. Specialties without "ownership" of patients will not have this bargaining chip. In addition, as mentioned earlier, hospitals could turn to CRNAs if anesthesiologists were not willing to work for the compensation offered. Hospitals could also turn to teleradiologists if the local radiology group was not content with the offered reimbursement. Pathologists may be better off, because I don't know if there is a "substitute" for their services.

Anyway, I don't want to paint an overly negative picture. And, FWIW, I think anestesiologists are UNDERPAID at the moment for the care they provide. I just think the future is very, very concerning-especially for the physicians who do not control patients.

 

[coprolalia]

The only possible upside I see, if this scenario plays out, is that physicians who are employees of the hospital are allowed to unionize and, therefore, collectively bargain.

-copro

 

[2win]

The only possible upside I see, if this scenario plays out, is that physicians who are employees of the hospital are allowed to unionize and, therefore, collectively bargain.

-copro

IF the law will allow us to have an union...The optimistic view is missing in tone with S&P and CNBC clowns. Welcome to the "new order"!
2win

 

[Good Solutions]

Bundling is rationing.

Rationing is paying less.

 

[powermd]

Bundling is rationing.

Rationing is paying less.

Bundling is rationing of dollars that may or may not lead to paying less.

Rationing is allocating a limited resource according to a plan.
Currently health care is rationed by ability to pay, whether 'you' are paying, or the provider is paying by taking a loss on your care.

Perhaps it should be rationed by some form of cost-benefit analysis instead. Since both doctor time and dollars are in short supply, this makes sense to me. Perhaps "doctor willing to provide service" and "payor willing to pay" is not the most efficient system for allocating health care dollars. From what I understand, people don't keep any particular insurance plan for more than an average of three years, so there is no incentive to the insurer to provide services that lead to long-term health improvement.

 

[coprolalia]

From what I understand, people don't keep any particular insurance plan for more than an average of three years, so there is no incentive to the insurer to provide services that lead to long-term health improvement.

Everybody has to pay into the system, if the system is going to work. The problem is that young, healthy people don't "need" healthcare insurance. Then, when they get older, they opt-in to the system. What they've paid up front is disproportionate to what they are going to extract, heavily in favor of the late entrant.

You have to think "herd protection" here. Laws that require everyone to pay, and people get a tax incentive to pay or fined if they don't (carrot-and-stick approach) is the only way this is going to work. And, it's the system we are going to go to, I think.

I'm starting to be a little more optimistic about the potential solutions to this problem... I think the timing, with the currently bad economy, is horrendous, though.

-copro