‘Bundled payment’ experiment by Bedford Surgery Center, Harvard-Pilgrim insurance
|By David Brooks, The Telegraph, Nashua, N.H.|
|McClatchy-Tribune Information Services|
That's one of the arguments for a pilot program between
"I think more and more bundled programs will be coming down the way -- it simplifies the system, reduces confusion, it's all up front," said
The pilot program, available to Harvard-Pilgrim customers, is prodded in part by changes in the health care system because of the Affordable Care Act and other initiatives. One result is more transparency about costs and thus cost shopping by patients, particularly for optional procedures like a routine colonoscopy.
"When physicians have a conversation with the patient and the patient asks for pricing -- that's easy," he said. "There are transparency initiatives underway by many of the health plans because more patients are asking how much is this going to cost me?"
The program has more than one bundle charge, based on various patient risk factors, but the actual charge for the colonoscopies isn't being made public to non-patients at this point.
"Everybody has the information they need, so there's not multiple tests ordered for the same thing. Everybody on the team (knows) we need to live within this budget; there isn't an endless writing of checks,." said
The idea of a set payment for a medical procedure, from insurers or other payers, is hardly new, but the concept has been dogged by concerns that it leads to reduced care or to the shifting of actual costs onto other patients whose payments aren't limited. The hope is that well-designed programs of bundled payments will avoid problems associated with more blunt pay-per-patient systems called capitation.
Harvard-Pilgrim hopes that its Bedford Surgery Center pilot, which has handled 44 patients as of earlier this year, will hone methods and systems to maintain quality while cutting actual costs, not just shifting them.
They started the pilot with screening colonoscopies -- the unpleasant but not dangerous process in which a camera on a flexible tube, known as an endoscope, is inserted into an anesthetized patient to examine the colon for signs of cancer -- because it is well-understood with relatively few complications.
Brewster said maintaining quality is easier because of the existence of quantifiable benchmarks for colonoscopies, such as reporting on polyps, presence of anesthesiologists when necessary, and detailed observation of the entire colon.
Just as importantly, he said, it establishes a framework in which all the parties communicate and can share patient records.
Bedford Ambulatory Surgery Center is an independent facility opened in 1993 and owned by its surgeons, although it has a relationship with
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