South Florida Hospital News
Sunday May 24, 2020

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July 2017 - Volume 14 - Issue 1




Important Factors to Succeed with the Bundle Payment Initiatives

The CMMS introduced the Medicare Bundled Payment for Care Improvement (BPCI) initiative in October 2013. The BPCI was designed to test whether linking the payments for all providers involved in delivering an episode of care could reduce Medicare cost while maintaining or improving quality of care. With this program there is a target price; a controlled payment that must be coordinated and distributed across various care providers. There are incentives which are aligned to value not volume.
 A number of different medical facilities are participating in this particular program including post-acute care centers, hospitals, and physician groups.
The research has shown reduction in cost, improvement in patient satisfaction and physician satisfaction and quality.
There are a number of factors that impact the success of the program:
(a) A clear leadership vision, and retraining of the champions of change is critical. A dedicated team is recommended for managing the change process; unfreezing, move to the new value model and refreezing new practices. All relevant departments/stakeholders inside and outside the hospital setting, should be aware of their impact on the outcomes of the program. A multidisciplinary approach encouraging collaboration is a key factor.
(b) Physician engagement is another important factor. Physicians who are reluctant to get on board should be made aware of the clinical research that suggests that the model is viable. Care coordination improves patient outcomes. With the clinical focus being on the patients’ journey to recovery, care management keeps them informed and engaged with the patients’ progress; ameliorating challenges, preventing hospital readmissions and ED visits, improving patient outcomes and patient satisfaction.
Discharge disposition is an area that requires physician involvement. Largest savings in the program is found in the reduced usage of institutional post- acute care. Physicians should be aware of impact of discharging patients to the most appropriate level of care. This area may require high touch approach for physicians who might be slow in buying in to the new model.
(c) Care Re-design; Retraining is also needed for the care management team to focus on care across the entire care continuum, over a ninety day episode of care. The relationship between the care coordinator and patient starts prior to admission to acute care setting. Care Coordinators manage the risk as patients transition from one care setting to another. Proper management of post-acute and care transitions, controls cost and improve outcomes.
(d) Data Collection; measure, monitor and report on quality and performance. Important to monitor performance, to make changes required.

The Healthcare Navigation Systems’ team has hands-on expertise in piloting the Bundle program. We can assist with improvement in readmission rates, care coordination support, Bundle revenue and software solutions. For more information, contact (561) 944-9011 or

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