Bundled Payment? Lets Start with the ‘RAPERs’!
Some of the health reform conversation has focused on bundled payment as a ‘bite sized’ basis of implementing change in the ‘whack a mole’ resistent health care borg. In response to a question on a LinkedIn thread entitled ‘Changing the Health Care Payment System: First Step Toward Real Reform?’
Breaking the cycle of health care payments complexity and errors may be one way in which to stem the cost of moving to a consumer oriented health care system, which is one of the popular solutions discussed during the health care reform debate. This concept of consumerism in health care and payments for services may be provocative to many readers of this blog but the facts as they stand currently demonstrate clearly that we have to start reform somewhere and fast. The current legislative efforts have provided little in the way of support for what the American people have expressed they want in the way of a public option so perhaps as an industry we can begin to resolve some of the issues that will be explored in this discussion. It is a fact that when compared to other business sectors such as retail, health care revenue cycle management is difficult at best, fraught with paper and consists of very little standardization. This is clearly an area that is replete with opportunity to drive new business, create jobs, and leverage existing infrastructure investments all while creating better efficiencies and timelier payments for providers.
The purpose of starting this discussion is not to position the arguments within as the only area of focus for the health care debate just a good start, and all efforts in other areas should continue in tandem. Consider that the health care industry supports bad debt in excess of 60 billion, spends more than $7,000 per person and almost 2.3 trillion dollars by some estimates. Certainly, this would point to an area ready for innovation and change. There will not be a “quick fix” to address these challenges nor is the author suggesting that it is the universal remedy not to mention that many readers will disagree with the points offered in this post. In essence that is the real point of this effort is to start an open, honest dialogue addressing the issues surrounding the payment system in the US Health Care system lest we continue to get more of the same, less individuals insured, spiraling costs and no hope of stemming the tide and effecting change.
I opine below:
Excellent discussion! I will noodle some more after digesting the entire thread, plus comments. Yet, what comes up for me is the ‘C’ word. Underlying health reform whether from the bleeding edge of payment reform, or any other logical portal of entry, i.e., HIT, nothing succeeds absent the ‘cultural’ context to receive and embrace its adoption.
So why not start with ‘seeding’ the cultural antecedents to merge (both clinically and financially) all hospital based physicians (HBPs), less affectionately known in the health plan contracting domain as ‘RAPERs’, i.e., Radiology, Anesthesiology, Pathology, Emergency Room docs? This is a logical nexus for bundled payments and rather compelling from the patient’s perspective too.
The notion of bundled payment is potentially sexy. It encourages, if not drives, the consideration of collaboration (& the ostensible alignment of interests) to accept and administer global payment for professional medical services rendered; and theoretically is more efficient and cost effective. Yet, in 2010 there is neither the administrative capacity, nor (outside of IDNs of the Mayo variety) cultural capacity for HBPs to risk experimentation with the financial and clinical collaboration required to co-exist under a bundled payment paradigm. Yet, no where else in medicine is the argument so compelling for such integration, imj.
Clearly, the nature of the exclusive ‘franchise’ often afforded to HBPs in my view augurs in favor of such integration even absent the ‘quid pro quo’ group culture typically required for its successful implementation.
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