While the recent cancellation of three mandatory bundled payment programs by the Centers for Medicare & Medicaid Services (CMS) has some questioning the future of value-based care, many providers have found success with bundled payments, particularly the voluntary models.
Since the 2011 release of the Bundled Payments for Care Improvement (BPCI), both hospitals and specialists have improved quality and lowered costs, but specialists, in particular, have demonstrated a greater opportunity to maximize the savings and outcomes. As the industry prepares for CMS’ next generation of the voluntary BPCI model, it is a great time for specialists to consider managing bundled payment programs.
Specialists are well-positioned for leadership and ownership of bundled payments. Under the first BPCI model, both physicians and hospitals saw success using bundles: lower costs, decreased length of stay, decline in skilled nursing facility utilization. However, across the board, specialists saw greater success in these measures. In fact, specialty practices that partnered with Archway saved at least $2,000 per case. In comparison, hospitals owning the bundles lowered their costs at an average of $864 per case, according to BPCI annual report prepared by the Lewin Group.
The reasons why specialists are able to outperform hospitals on bundles are due to the nature of the patient-physician relationship. Specialists truly know the patient beyond what’s documented in their medical records. They know the nuances of the patient’s case like their personalities, support available to them post-op, likelihood of adherence to post-discharge medication and care instructions. As the performers of surgery, they also intricately understand the nuances of the procedure, and are able to identify pockets of overutilization before, during and after the operation.
Given that hospitals are larger, and typically manage more patients than physicians, it can be tough for them to be nimble and provide personalized service in large quantities. Additionally, conflicts of interest that physicians do not typically have can come into play. Many hospital systems own skilled nursing facilities or home health agencies, and may be inclined to refer patients to these services, even when it is not necessary. Hospital administrators are aware of their vulnerabilities and have systems in place to counteract them, but data shows that when it comes to bundles, physician-owned episodes produce better results.
At Archway, we champion specialists. We believe they are optimal partners to own the bundle, and we are solely focused on helping them succeed in bundled payments by partnering with them to evaluate, design, and manage customized programs. No matter who specialists partner with in their bundles, we believe all specialists should prepare for participation in bundled payments—they are here to stay.