Bundled Payment Pilot Project Results, and New CMS Pilots
This article looks at the results of the PROMETHEUS Payment pilot project, which one of several bundled payment pilot projects. The project is discussed in the November 2011 edition of Health Affairs.
But after three years of efforts, not a single bundled payment had been made, or a contract even entered into. All three projects lagged “months or years behind their planned milestones,” said the study published in the most recent edition of Health Affairs, notes the Wall Street Journal blog.
The primary culprits were determining payment rates—a process hobbled by issues analyzing claims databases—and getting those rates to interface with the insurers’ claims processing systems. According to recent study of the Prometheus system by Washington-based RAND Corp., the primary reason the organization was unable to achieve its goal of making bundled payments to providers despite three years of work was “the complexity of the model and the fact that it builds on existing complex health care systems.”
However, researchers have suggested that the efforts have helped better coordinate care at all three systems, and that advances in technology could make future bundling efforts progress more smoothly.
Interesting to note is the article by Uwe Reinhardt recommending an industry-wide switch to an “all-payer system”, similar to what Maryland does with hospital payments. Under such a scenario, the prices for health care services and products are subject to uniform price schedules that are either set by government or negotiated on a regional basis between associations of health insurers and associations of providers of health care. (Source)
CMS’ Center for Innovation is currently accepting applications for the Bundled Payments for Care Improvement Models 2-4. For more information on the bundled payments pilot projects CMS is conducting, visit this page.
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