"If I were in charge of bundled payments, I'd look for the lowest cost partner with the best chance of avoiding a readmission..."

I was reading a website's FAQ recently and thought to myself how helpful FAQ's can be at getting to the core of my questions and answers regarding a complicated topic.  

With that in mind, here is something similiar to an FAQ, a series of questions and some suggested answers regarding the topic of bundled payments and how they may play a part in home care.

What's a Bundled Payment?

Great Question!  Bundled Payments are a new way that certain procedures will be reimbursed.  Ultimately, CMS (the Medicare and Medicaid people) will make one fixed-price payment for a procedure (like a knee replacement) that covers the whole procedure and associated recovery.  This differs from the historical fee-for-service model of reimbursement where, for example, the knee surgery would have one payment, the post-acute recovery in a nursing home or with home care would have a second payment, and a readmission would have a third payment.  (Read more about bundled payments).

Who Will Divvy Up the Bundled Payment?

Following up on the knee replacement example, the surgeon and the hospital are the big players and they'll get the bundled payment and decide how to divvy it up.

Won't They Want to Keep Most of the Money for Themselves?

Of course they will!

Today My Home Health Agency Gets Up to $3,000 for nursing and PT. Is That at Risk?

Yes, very much so!

Who Will They choose?

Another great question!  I opened this blog by saying that if I were in charge of bundled payments, I'd look for the lowest cost partner with the best chance of avoiding a readmission...  

This is just logical...  I definitely won't want a readmission because it will come out of my pocket, so I'll do everything in my power to avoid a readmission at the lowest price possible.

Imagine that you are personally paying out of pocket for the post-acute care for people with knee replacements.  What would you do?  Let's say that you had a very healthy young patient not on blood thinners who took personal responsibility for their recovery? (Note - I was this patient in the summer of 2015). Perhaps you'd send them home with no post-acute care except for a youtube video of exercises that they should do and you'd have an automated phone call check in with them every 5 days to make sure nothing's going wrong.  Then you'd have them visit your NP a couple of times to make sure they're on track. 

Hmmm...  My Home Health Agency Might be Cut Out of the Loop!  Any advice?

Yes - I'm glad you asked...  What if you set targets for the number of visits per episode (like 6 instead of 15), personally approved any episodes with more visits and gave the nurse in charge a bonus if they do it with fewer visits?  Then, since you’re doing fewer visits, what if you added automated phone calls (available for 50 cents per day) to check in on them and let the nurse case manager if they're off track.  Then I'd keep detailed records of my costs, visits and success rate and I'd use this to market my services.

How Can I Learn More?

A few resources that can help you are as follows:

• Selling Care Transition Services to Hospitals 

• Remote Patient Monitoring and Readmission Avoidance for 50 cents a day 

If you're interested in scheduling an online demo of our home care or care transitions software solutions, just click this button:

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