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Getting Ready for Bundled Payments in Cardiac Care

Mary Caffrey
Two consultants who help stakeholders in value-based transitions say CMS is serious about an aggressive pace for payment reform.
Putting Patients First. Hand-in-hand with care coordination, Cameron said, is the need to give patients a single point of contact. She witnessed this firsthand when her husband had bypass surgery in 2008, and he had an endless stream of phone calls from different providers involved in his care. At one point he asked, “Donna, who is my quarterback?” He wanted to who was in charge, but Cameron said, “That is not how our healthcare system has been built.”

Abrams agrees, and said this demands close attention to how reimbursement is structured. Making separate payments for getting patients to rehab or a nutrition class instead of paying for outcomes misses the point, he said. “We should be making sure all of the provider organizations are accountable for getting a good outcome, not incentivizing on a piecemeal basis,” he said.

 Resistance in Some Quarters. The American Hospital Association (AHA) did not reject the cardiac bundle concept, but questioned whether providers had the bandwidth to make the shift alongside the new hip-and-knee program, as well as compliance to the 2015 Medicare Access & CHIP Reauthorization Act. “CMS is putting the success of these critical programs at risk,” AHA Executive Vice President Tom Nickels said in a statement. “Hospitals are under a tremendous burden to ensure these complex models work for patients.”

Resistance isn’t universal, however, as Blaber’s response shows. Some providers are further along the path to payment reform than others, and Cameron and Abrams don’t see CMS putting on the brakes. “This is more evidence that CMS is very committed to accelerating the transition to value-based payment models,” Cameron said. Abrams thinks the proposal means that hospitals with high cardiac care costs that have avoided value-based models will be pushed to do so under the new bundle model.

What are the barriers to doctors and hospitals seeing success with cardiac care bundles? Both Cameron and Abrams say it’s a combination of solving technical hurdles—like making sure physicians can get timely feedback from payers—to changing the mindset.

Cameron said organizations have to ask: how are we providing education? Who are the internal “experts” charged with creating good communication plan, and getting buy in from all the stakeholders? “We finding that organizations that are successful take a very patient-centered view,” she said.

Abrams, whose group works across the entire healthcare continuum—educating providers, insurers, pharmaceutical manufacturers and device makers—said taking on risk and being accountable for outcomes is a sea change for many, and his company’s recent survey bore out out the “readiness gap” for value-based care. “It didn’t surprise us to find that the overwhelming majority were just dipping their toe in the water,” he said.

The question, he said, isn’t whether hospitals and doctors are ready, but whether CMS has any choice but to press ahead, given the age of the baby boomers. Officials have said 50% of all Medicare payments will be based on alternate models by 2018, and a recent McKesson report—which also highlighted the readiness gap—said value-based models would eclipse fee-for-service by 2020.

“I realize that the changes involved in adapting to value-based care models are extensive,” Abrams said. “But I don’t think we have the luxury of taking it at a pace that makes everybody comfortable.”

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