bundled paymentsRecent analysis has proven that bundled payments are proving to be highly productive in transforming the health care system in a positive manner – especially as they relate to surgeries that are orthopedic in nature.

A recent report states, though, that more research will be required in order to outline all of the benefits associated with the initiative referred to as the “Bundled Payments for Care Improvement”, or, “BPCI”, for short. Bundled payment methodologies originated in the year of 2015 when the Centers for Medicare & Medicaid Services (CMS) initiated them for hip replacement surgeries and knee replacement surgeries.

This originated as a means to provide medical professionals with a large lump sum payment for providing high-quality care at the lowest cost possible – starting at the point of surgery through the actual recovery process.

Since the original roll-out of the bundled payments, surgical treatments and recoveries for fractures of the femur and fractures of the hip have been added. Additionally, cardiac-based care has also been added to the bundled payment models.

The purpose and intent of the BPCI was to determine if linking provider payments for medical providers responsible for delivering care would reduce the costs linked to Medicare while – at the same time – maintaining or providing an exceptionally high amount of quality care to patients.

Those that are awarded by the BPCI included – but, are not limited to – primary care providers, post-care professionals, specialized groups of physicians, as well as hospitals. Overall, the BPCI is a program that is designed to provide rewards those responsible for patient care – if that patient care proved to be high in quality and productive to their overall health and well-being.

The rewards offered to medical professionals is based on the payments that they have previously charged in the care and treatment of patients. If the episodic payments are found to be below the price that was previously targeted, they are eligible to receive a net payment from reconciliation amounts (NPRA). In turn, the providers/medical professionals may elect to keep the rewards that they receive or they may elect to share it with those providers that partnered with them to successfully care for and treat patients.

Unfortunately, if the provider/medical professional is found to be above the targeted prices, they may find themselves having to return a portion of the proceeds to CMS. This, in turn, encourages and motivates the medical providers to lower each of the episodic costs, per patient.

A lot of evidence was gathered on the findings from a multitude of medical providers. While there is a mixture of positive results and negative results, it was found that there is a potential for a massive amounts of savings – as it pertains to Medicare.

Professionals believe that the bundled payment models are actually transforming the health care system – for the better. The innovative models pertaining to both care and delivery are providing a strong level of support for medical professionals. Tax dollars are being spent more wisely and patients are receiving better care.

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