Bundled payments?

[NOsaintsfan]

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http://www.medpagetoday.com/PracticeManagement/Reimbursement/49727

Anyone have any idea of the actual implications? I realize that income is going to fall but does anyone have a number for what anesthesia reimbursement will be under a bundled payment system?

 

[deleted171991]

In a bundled payment system, your group or dept will get exactly as much as you negotiate. Since there will be anesthesiologists on every corner, and since you don't bring patients to the hospital, guess how big that power of negotiation will be.

 

[sleepallday]

Bundle payments are already here. According to our billing department, for 2015 ultrasound use and TAP blocks are bundled together. No more ultrasound usage code when doing TAP blocks.

 

[seinfeld]

I think the biggest question is to whom the bundled payment would go, ie who gets the lump sum and who divides it up. I honestly favor the surgeons over hospital. My problem with bundled payments is that no matter who the money goes to it on some level means you are being reimbursed for receiving a consult. If you agree to a lower fee , you'll likley get more business, is that a "kick back" to the surgeon or hospital for the consult if you agree to taking less of the whole payment?

Initially to negotiate a bundled payment you would take you average billings for all similar cases for a particular surgeon, include the potential for bring backs based upon the surgeons specific rates and then arrive at a "number". You also have to take into account the percentage of medicare versus private payers and then all the different contracts you have for the insurances. We do this for all elective, true self pay cases where a surgeon guarantees volume , ie bariatrics or Canadian resident for joint or heart surgery

 

[deleted171991]

Legally, it's not kickback. It's like choosing the cheapest supplier.

My guess is that the ACOs, meaning the hospitals, will decide how to divide the bundled presents. They will be the ones being paid, not individual physicians.

Unless they stop implementing the ACA...

 

[seinfeld]

I agree that legally will be OK but teleologically it is the same thing

Say that between the surgeon and Anesthesia the combined payment is $2 to the surgeon and $2 to anesthesia and $2 to hospital. If the anesthesiologist gives $1 to the surgeon for using his/her services this would be a kick back. But if the bundled payment was $6 and the anesthesiologist agreed to a $1 payment and the surgeon received $3 and the hospital $2 this is considered a success. The endpoint is the same.

 

[aneftp]

Legally, it's not kickback. It's like choosing the cheapest supplier.

My guess is that the ACOs, meaning the hospitals, will decide how to divide the bundled presents. They will be the ones being paid, not individual physicians.

Unless they stop implementing the ACA...

I would not count of ACOs.

So far close to a 50% drop out rate of ACOs.

http://hitconsultant.net/2014/10/07/pioneer-acos-dropout-providers-leaving/