This is the year bundled payment for Comprehensive Joint Replacement is being rolled out by Medicare. Rehabilitation professionals are not directly included in the payment model yet. This doesn't mean that rehab providers should not be devoting time preparing for bundled payments.
Medicare is typically straightforward and does not allow for negotiating. Other payers though, like direct contract self-insurance, third party administrators, and commercial insurance companies allow for contract negotiations. Do you have what you need today to negotiate for tomorrow?
Step 1: Data:
1) The effectiveness of your services.
2) The efficiency of your services.
3) How your services compare to other providers.
4) Payment received for an episode of care in a fee for service payment model.
5) The cost to deliver service at a defined level of quality.
6) The overall patient demographics snapshot of those typically receiving your care: when symptoms occurred compared to when services initiated, age, overall health/comorbidities, number of surgeries, exercise history... to name a few.
Step 2: What you will need from the payer:
1) What is the anticipated number of patients in targeted population to be directed to your care?
2) What is the overall health of the patient population?
3) When will services be initiated after onset of symptoms?
4) What is the anticipated number of visits with other medical professionals prior to initiating rehabilitation services?
5) What is the estimated bundled payment?
Step 3: Compare payer information with your data:
1) Will there be a high enough volume of patients directed to your care to make going forward feasible?
2) Does the overall health data for the projected patient population appear similar to your current patient demographics?
3) Will there be an anticipated change in the care pathway valuing rehabilitation professionals?
4) How does the bundled payment stack up when you compare your costs, your typical patient population and previous payments? What is your anticipated profit? Does the estimated bundled payment meet your expectations?
5) Do you forsee any total cost of care savings that may occur due to the new proposed arrangement?
Step 4: Discussion points with payer:
1) Differences noted between the two sets of data (yours and theirs).
2) Negotiate the bundled payment: when payment will be received and what the payment will be based upon. Include a level of quality that will be met.
3) Evaluate financial reward based on delivering results that reach outside of the episode of care.
4) Determine an additional payment based on a percentage of the total cost of care savings.
Step 5: Evaluate your current practices and processes:
1) Is there any way to deliver high quality of care with less professional time with the patient?
2) Are there resources in your community that could be harnessed to help with care delivery?
3) Do your patients typically have their own resources that have not been adequately used in the past?
4) Are there ways to ensure more quickly that your patients will achieve the desired outcome?
5) Do you have the right processes and resources currently in place to help manage patients adequately with regard to clinically deciding when to end services?
Judy Holder enjoys helping you with having the right data for contract negotiations.
Until next time,