CMS To Require 800 Hospitals to Participate in Bundled Payments

CMS To Require 800 Hospitals to Participate in Bundled Payments


The Centers for Medicare & Medicaid Services issued a proposed rule which would require hospitals in 75 geographic areas to participate in a test of bundled payments. The planned rule would make hospitals bear the risk for hip and knee surgeries – among the most common that Medicare beneficiaries receive, and of which the price can vary significantly.

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The program would begin 1/1/16 and run for 5 years, with hospitals not set to bear risk until year 2. The hospitals would continue to be paid under Medicare’s fee-for-service system with reconciliation occurring at the end of the year and determining if the hospital would receive an additional payment, or be required to pay in to Medicare.

The proposals signals that the administration is serious about rapidly moving away from fee-for-service and committed to the goal shared by HHS in January of having 50% of its fee-for-service spending under contracts that include cost and quality incentives.

It is very clear that now is the time for hospitals that have yet to make necessary investments in data infrastructure or care coordination to do so. Good news: there is a proven solution in the marketplace – PinpointCare – that addresses care coordination for hip and knee, and one that enabled a large orthopedic surgery group to improve efficiency and reduce costs by more than $3 million in one year.

PinpointCare IBJI

Galen Healthcare Solutions is collaborating with PinpointCare, a pioneering coordinated healthcare company, as an authorized Value-Added-Reseller of its one-of-a-kind platform for patient engagement, care coordination and management. The PinpointCare platform allows the care team to create a personalized and dynamic care plan to support patients through all phases of care. An easy-to-use dashboard allows the care team to closely monitor adherence to the care plan while the web-based platform is available anywhere, anytime and allows real-time collaboration regardless of setting: acute, ambulatory, rehabilitation, skilled nursing facility, home health or outpatient physical therapy.

To learn more about how PinpointCare would allow your hospital to comply with the proposed plan, improve care coordination and reduce costs, please contact us.

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