Healthcare Bundled Payments Hinder Skilled Nursing Facilities
Skilled nursing facilities are "under pressure” when transitioning their reimbursement structure toward healthcare bundled payments.
By - How are skilled nursing facilities and other post-acute care centers handling the transition to a value-based care reimbursement environment? Fitch Ratings stated in a press release that many post-acute care providers are finding it difficult to operate in the value-based care arena even in the midst of early stages for healthcare bundled payments.
Skilled nursing facilities struggle with bundled payment models
At this point in time, healthcare real estate investment trusts (REITs) have been working to better align post-acute care and skilled nursing facilities with healthcare bundled payments. The Centers for Medicare & Medicaid Services (CMS) along with private, commercial payers have positioned healthcare bundled payments as a way to improve coordination as well as ensure reimbursement is based on value and a specific episode of care.
Some healthcare REITs have gone forward with modifying lease terms with skilled nursing facilities while others are interested in becoming net sellers, according to the release. These type of moves are associated with the fact that these tenants may need additional time a flexibility to better transition to value-based care reimbursement.
Even when small numbers of patients are affected in the pilot programs using healthcare bundled payments, Fitch Ratings states that skilled nursing facilities will still be “under pressure” during the transition. However, when interviewing post-acute care providers, Fitch Ratings found that these clinicians were “cautiously optimistic” when it comes to their financial outlook for next year.
Why mammography may succeed with healthcare bundled payments
Whether or not skilled nursing facilities will see success when implementing healthcare bundled payments remains to be seen, but a new study from the Harvey L. Neiman Health Policy Institute shows that mammography may be a positive area in which healthcare bundled payments could be incorporated.
The researchers looked at the areas in which healthcare bundled payments had been used and decided that these new payment models had to be incorporated in clinical settings beyond that of primary care and hospital stays. As such, the study delves into mammography services.
“In an effort to curb healthcare costs and improve the quality of care, bundled payment models are becoming increasingly adopted,” Danny R. Hughes, PhD, Neiman Institute Senior Director for Health Policy Research and Senior Research Fellow, said in a public statement. “To date, these models have focused primarily on treatment episodes and primary care providers. To achieve current Medicare goals of transitioning fee-for-service (FFS) payments to alternative payment models, a broader range of patient episodes and specialty physicians will need opportunities to participate.”
The study was published in the Journal of the American College of Radiology (JACR) this past August. The research points at the potential for creating bundled payments for breast cancer screening from the radiologist’s perspective.
The researchers used Medicare claims data and other data from a private hospital system to create a healthcare bundled payment. The bundle began with a mammography screening event and followed further diagnostic breast imaging services lasting about 12 months.
However, the researchers also note that the study does not set up a specific pricing model for the Centers for Medicare & Medicaid Services (CMS) or private payers to follow. This means that public and private payers will need to set up their own prices to figure out how much an episode of breast imaging services will cost.
“As the U.S. health care delivery system transitions from FFS to value based payments, it’s important that we [radiologists] are at the table to ensure that our patients have access to high quality imaging,” Geraldine McGinty, MD, MBA, FACR, Vice Chair of the American College of Radiology (ACR) Board of Chancellors and a member of the Neiman Institute’s advisory board, stated in the press release.
“Shaping payment policy to support that access is at the core of the ACR’s mission. Bundled payments are seen by policymakers as a vehicle for aligning incentives and in fact the Centers for Medicare and Medicaid Services (CMS) have now imposed mandatory bundling for joint replacement and cardiovascular care.”
Nonetheless, the study offers a framework in which health payers can work with radiology providers to create a healthcare bundled payment that would work for their particular patient populations.
The study assessed the role risk plays in creating a bundled payment model. However, the results show that incorporating patients at higher risk of medical conditions did not cause any significant changes in the overall bundle cost.
The researchers conclude that using bundled payment with breast cancer screening could lead other specialty services to adopt value-based care reimbursement strategies in the long-run.
“Aside from serving as a model to demonstrate how diagnostic radiologists can participate in bundled payment models, this research initiative has the potential to fundamentally change the way mammography is paid for in this country. Because screening bundles include costs for follow-up diagnostic imaging in addition to the initial screening mammogram, patient adherence to screening guidelines may improve – which may have profound effects on public health in a way that’s great for patients, providers and payers,” Hughes concluded.
While skilled nursing facilities may need further assistance in supporting bundled payment models, the use of the bundle in reimbursing hospitals, clinics, primary care practices, and specialty providers could be a worthwhile endeavor to pursue.
Dig Deeper:
How to Overcome the Challenges of Bundled Payment Models
How Payers Should Prepare for Value-Based Reimbursement
