Bundling…Will we urvive捆绑……我们会活下来.pptVIP

Bundling…..Will we survive? Bundling…..Will we survive? Bundling How Will We Survive ? A bit of History In 1972 Congress enacted legislation to create a way to finance End Stage Renal Disease (ESRD) In 2008 Congress passed the Medical Modernization Act (MMA) as well as the Medicare Improvements for Patients and Providers Act (MIPPA) these acts required the Centers for Medicare and Medicaid Services (CMS) to look at the elimination of payments that were separately paid for dialysis services and drugs. Bundling is the solution CMS has proposed Estimated point prevalent ESRD patients Figure 11.3 (Volume 2) Total Medicare dollars spent on ESRD, by type of service Figure 11.5 (Volume 2) Total Medicare ESRD expenditures, by modality Figure 11.6 (Volume 2) Total Medicare spending on injectables Figure 11.13 (Volume 2) Why change? In a separately billable system certain services are billed for as “composite” and others are billed for as “separately billable”. This system left some question as to the profit margin some dialysis units reported. If all services were equal why did some units make more money than others? Proposed* Changes Payment will be on a per treatment basis All drugs and labs will be included All renal service oral drugs including Phosphorus binders All labs ordered by Nephrologists or others Reimbursement would “trim 2% of the estimated payments that would have been made in 2011 under the previous payment system” No adjustment for Race/Ethnicity Wage Index Adjustments are likely Proposed* Changes (con’t) Units will have the option of easing in over 4 years or going 100% at one time The Math…… 2007 claims data proposed the 2011 rate would be $261.58 CMS is proposing a 21.73% reduction = $204.74 Proposed Outlier Adjustment 1% reduction = $202.69 MIPPA required a 98% reduction = $198.64 Problems Old data may have been used – cost reports etc. in some cases are dated No consideration of inflation Certain areas of the country will get less r