“Clinical integration holds the promise of greater quality and improved efficiency in delivering patient-centered care,” the AHA’s Trendwatch report stated. It predicted payors will change to reimbursement methodologies that “put a premium on the ability of providers to collaborate effectively.”
The detailed report cites examples of integration at various hospitals and makes the following points:
- MedPAC has recommended replacing Medicare fee-for-service payments with a system that “would pay for care that spans across provider types.” Toward this end, MedPAC suggested using medical homes, bundled payments and providers organized into accountable care organizations.
- CMS is conducting several Medicare demonstration projects to test payment and delivery reforms that rely on enhanced clinical integration. In a demonstration at Continuum Health Partners in New York, participating physicians achieved cost savings of $900 per admission, twice as much as non-participating physicians.
- Hospital efforts at clinical integration span a broad spectrum of arrangements, from targeted initiatives with physicians on staff, such as working with orthopedic surgeons to reduce implant costs, to totally integrated systems where physician groups and hospitals are under the same ownership. In the middle of the spectrum, some hospitals are employing a substantial number of physicians or cooperate closely with their physician hospital organizations.
- Legal barriers to integration include the Civil Monetary Penalty statute against gainsharing and the Stark and anti-kickback laws. In a Dec. 2009 letter to the Justice Department’s Antitrust Division and the FTC, several U.S. senators asked for “clear and accessible guidelines on forming collaborative care models.”
Read the AHA Trendwatch Report on clinical integration.
