It’s likely that the majority of your stroke patients are covered by Medicare so you should be aware that, in 2019, hospitals are going to be offered an advanced Medicare “bundled” payment model for stroke.

Medicare bundled payments represent a single payment (usually to the hospital) for services provided during an episode of care for a defined period of time. In this payment model for stroke, Medicare pays the hospital one “bundled” payment which includes payment for hospital, physician and rehabilitation services. It is up to the hospital to pay physicians and rehabilitation facilities for their services.

Medicare uses their claims database to find areas where there is unexplained variation in patient level cost across hospitals. They identify types of care and more specifically, episodes of care where they feel there is opportunity, given the right incentives, to reduce variation, reduce cost and improve quality of care.

While stroke has been one of 48 episodes of care offered to hospitals for several years, few hospitals have chosen stroke for bundled payments. But that may change.

Bundled Payments for Care Improvement

Stroke represents a hyper-acute stage of hospital care followed by a transition to rehabilitation or skilled nursing home and, with more tightly coordinated care in certified stroke centers, stroke may be viewed as an ideal episode of care for bundled payments.

With prompt diagnosis and treatment, adoption of evidenced-base protocols, more longitudinal coordination of care and improved patient outcomes, more hospitals may be interested in the financial incentives offered in the new advanced bundled payment model for stroke.

If you work with your revenue management (or hospital reimbursement) team, with some analysis of the cost of different types of stroke in your hospital, you may be the one to advocate for (or perhaps, against) bundled payments for stroke for your hospital.

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References:

Washington Health Alliance. Hospital sticker shock: A report on hospital price variation in Washington state. https://wahealthalliance.org/wp-content/uploads/2014/10/hospital-sticker-shock-report-chart-pack.pdf.

Luengo-Fernandez R, Gray AM, Rothwell PM. Costs of stroke using patient-level data: a critical review of the literature. Stroke. 2009;40: e18–e23. doi: 10.1161/STROKEAHA.108.529776.

Miller DC, Gust C, Dimick JB, Birkmeyer N, Skinner J, Birkmeyer, Large variations in Medicare payments for surgery highlight savings potential from bundled payment programs. Health Aff (Millwood). 2011;30:2107–2115. doi: 10.1377/hlthaff.2011.0783.

Newhouse JP, Garber A, Graham RP. Interim Report of the Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Health Care: Preliminary Committee Observations. Washington, DC: The National Academies Press; 2013.