Hospitals are on the Hook—Bundled Payments Expand

by Andy Beer on Sep 2, 2016

At the heart of healthcare reform is the shift to value and focus on outcomes. This is evident once again in thecardiac.jpg Centers for Medicare & Medicaid Services’ (CMS) recent bundled payment expansion.

Back in April, the Comprehensive Care for Joint Replacement (CJR) value-based payment rule took effect. In the CJR model, hospitals in select markets are financially responsible for the quality and cost of an “episode of care” for hip and knee replacements, from admission all the way through 90 days post-discharge. The “episode” includes all related items and services, including post-operative imaging exams, paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries.

The recent expansion of bundled payments will require hospitals in 98 randomly selected metropolitan markets to be financially responsible for the cost and quality of care associated with bypass surgery and heart attacks. According to CMS, hospitalizations for just 200,000 beneficiaries with heart attacks cost Medicare $6 billion in 2014.

So how do these value-based payments impact imaging?

More Risk Requires Streamlined Care

Now that hospitals are on the hook for an entire episode of care through 90 days post-discharge—efficient imaging is essential. Each re-scan is another tally on the hospital’s bill. So, how do imaging providers balance risk while providing high-quality patient care? One way is advanced imaging technologies.

By investing in advanced imaging equipment, radiologists can make a more accurate diagnosis—reducing the need for rescans and improving the patient experience. For some hospitals, having the newest imaging technology isn’t always a fiscal possibility, but there are many high-quality refurbished imaging systems on the market that can improve imaging confidence.

Prepare for Bundled Payment Expansion

It’s hard to say where bundled payments will go next, but they likely will continue and radiology needs to have a seat at the table. Just recently, researchers at the Journal of the American College of Radiology suggested that mammogram reimbursements would work best as bundled payments.

Healthcare providers across the country—and even in much of the world—are under enormous pressure to reduce costs and improve care quality. It’s really no surprise that cardiac care is being especially scrutinized—with multiple initiatives under way to reduce and eliminate inappropriate testing.

Learn more about the new era of value-conscious cardiac imaging in our trend report.

Have value-based payments impacted your imaging department? Share your comments below.


Meet the Author

Andy Beer is the executive vice president at Cassling. He received his business administration degree at Iowa State University and completed the Alternative MBA course at the University of Minnesota Carlson School of Business. Andy is a veteran of the diagnostic and medical imaging industry. He spent 12 years at Siemens Medical Solutions where he gained direct sales and management experience before joining Cassling in 2002. While at Siemens, Andy received a number of company awards and honors, including the Circle of Excellence Award and the Masters Award. He stays involved in the community by donating time to his church and coaching youth basketball.

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