The proposal wouldn’t affect doctors in 75 geographic areas, as they will be paid under the existing system, but it would result in changes for hospitals that perform hip or knee replacements.
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“Each player knows he or she is one part of the composition, and only by working together does the music come alive”, says Sylvia Mathews Burwell, secretary of Health and Human Services.
“For instance, the rate of complications like infections or implant failures after surgery can be more than three times higher at some facilities than others, increasing the chances that the patient may be re-admitted to the hospital”, the agency said. And, the average Medicare expenditure for surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas.
Andy Slavitt, who has served as acting administrator of the Centers for Medicare and Medicaid Services since the beginning of March, has been nominated to be permanent head of the Medicare agency.
Bundling the payments is an incentive for patient care, a patient-centered approach, Burwell said. Data utilization, spending information and sharing of best practices will be provided to hospitals to aid in improving coordination of care between physicians, home health providers and nursing facilities. It will reward providers and doctors for helping patients get and stay healthy.
The five-year mandatory model would give healthcare providers a standard set of quality measures, including measures for complications and readmissions.
Depending on the hospital’s quality and cost performance, it might receive an additional payment or be required to repay Medicare for a portion of costs. A comment period, which will last for 60 days, will first be held, after which the succeeding steps will be determined on whether the goal of providing better quality care at lower costs will be achieved.
These bundled payments for joint replacement surgeries would build upon successful demonstration programs already underway in Medicare.
The health care provider themselves would continue to be reimbursed under the current Medicare model, according to the release.
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CMS invited hospitals and medical providers on Thursday, July 9, to gather comments and opinions regarding the proposed new payment scheme.
