WBB's Thought Leadership

Strategic Implementation of IT Systems Key for Successful Bundled Payment Models

June 7

The future of healthcare will most likely include bundled payments, and IT interoperability across many settings and specialties will be key in this transition.

The goal of the bundled payment reform is to increase quality of care and reduce costs. Experts in the healthcare industry are excited about the initial interest from physicians and administrators about bundles payments, but recognize that the structure has to be sound before implementation can occur.

Excerpt: “The future around bundled payments appears somewhat clouded, at least for the near term. This past week, the Centers for Medicare and Medicaid Services delayed the start of mandatory bundled payment models—for cardiac and orthopedic care, and for the Cardiac Rehabilitation Incentive Payment Program—to January 1, 2018, from May 20, 2017. The CMS’ final ruling will affect episode payment models that target 90-day care episodes.

“However, experimentation is already underway. Today, approximately 1,300 hospitals, physician groups and post-acute providers nationwide participate in the CMS’ voluntary Bundled Payment for Care Improvement (BPCI) model. These providers are redesigning and improving care delivery for one or more of 48 conditions. Commercial payers also are starting to align with CMS’ bundle definitions as healthcare continues to undergo a transformation in both payment models and care delivery.”

“Despite the delay of the mandatory program, the general consensus is that the overall approach for bundled payments is here to stay in some form for both public and private payers. Bundled payments represent the ultimate form of accountability, by linking the payments made by a payer for multiple services a patient receives from providers during an episode of care. These arrangements with providers are intended to ultimately place focus both on financial and performance—which includes quality, patient satisfaction and more—thus representing a dramatic shift from fee-for-service arrangements.

“Bundled payments also represent a sea change for providers’ use of information technology. It will place growing demands for interoperability that enables the exchange of patient information for all providers who treat a patient receiving care under a bundled arrangement. It will also burden provider billing systems, which now are currently designed around tracking patient services and billing for them in a fee-for-service model. Finally, systems will need to ensure high-quality care, eliminating medical errors and promoting best practices that achieve the best possible results.”

SourceHealth Data Management

WBB Take: News articles over the last two years have spoken to how ill-prepared many facilities and practices are with regard to their IT systems and the ability to deal with the MIPS/APM requirements of MACRA.

However, the same issue was uncovered during previous policy implementations, such as the rollout of ICD-10. One of the foundational problems is that many facilities do not perform adequate IT requirements, scoping, and planning as part of clinical data upgrade projects or when new payment models or measurement policies are implemented. One cause is the lack of IT involvement in clinical operations planning. An effective  approach for identifying potential IT gaps and weaknesses is to use Critical to Quality (CTQ) and Knowledge Auditing tools. A CTQ Tree can identify all the components and activities required in the value chain for a successful implementation of a new payment model or measurement system. A Knowledge Audit identifies what each actor in that value chain needs to know at each step, and how they will know it at the time of execution. This approach will identify weaknesses in staffing, training, and IT systems alike.

Weaknesses in IT systems will typically be evident when the Knowledge Audit asks “how does THIS person know THIS information at THIS moment?”, and the answer is that they will be presented with that knowledge by a non-existent report, screen, or field.

Cited by Shannen Irwin


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