Bundled Payments in Healthcare – The Next Generation
Overview:A bundled payment is a single re-imbursement to a healthcare provider for all clinical services related to a single instance of medical care and away from fees-for-service.
Bundling of payments to healthcare providers will be used more frequently to reduce the cost of healthcare in the United States. Theoretically, bundled payment schemes will improve the quality of care, reduce un-necessary care, and reduce variation in cost among payers. However, research results are varied. Pilot projects such as Prometheus have been slow to develop because of the difficulty of agreeing upon which services can be bundled.
Provisions for bundled payments are included in both the Patient Protection and Affordable Care Act (PPACA) and the Affordable Health Care for America Act (AHCAA). The PPACA bill established a national Medicare program in 2013. The AHCAA bill requires reform of Medicare payments for post-acute services, including the bundled payments.
Healthcare legal counsel face a number of legal and regulatory issues in structuring bundled and gain-sharing payment systems. The legal challenges arise from insurance, state laws, provider relationships, and fair market value dis-agreements. In the past, these arrangements were found potentially to violate the Anti-Kickback statute and Civil Monetary Penalties Act.
Our panel of skilled practitioners will review bundled payment schemes and discuss the advantages and disadvantages of the schemes. The panel will discuss operational and regulatory concerns for healthcare providers, critical provision documentation, the effects of healthcare reform and other recent legislative, regulatory, and enforcement activities. Also addressed is gain-sharing.
Key Topics include:
- Public and Private Bundled Payment Initiatives & Gain-sharing Arrangements
- Bundled Payments Programs and Current CMS initiatives
- Implementation and Operational Challenges
- Accountable Care Organizations (ACOs) and Bundled Payments
- Medicare Bundled Payments for Care Improvement (BPCI) Initiative
- Bundled Payment Transparency and Risk Arrangements
- Bundled Payment Documentation, Data Analysis, & Reporting
- Legal and Regulatory Compliance Issues
Christopher Wilson, Senior Manager
Pershing Yoakley & Associates, P.C.
- Bundled Payment Activity
- Selecting bundled payment provider and payer partners
- Developing performance criteria and metrics
- Performing advanced analytics on claims and clinical data
Jessica Walradt, M.S., Senior Payment Reform Specialist
Association of American Medical Colleges
Using Data to Inform Episode Selection in BPCI
- The importance of volume
- Medical vs. surgical bundles
- Identifying opportunities and challenges
Who Should Attend:
- Medical Directors
- Hospital CEOs and CFOs
- Healthcare Lawyers and Counsel
- Medical Analytic Specialists
- Medical Insurers
- Quality Improvement Executives
- Managed Care Executives
- Managed Care Contracting Experts
- Health Plan Representatives
- Information Technology Vendors
- Health Policy Makers
- Physicians and Physician Organizations
- Healthcare Technology Managers
- Information Technology Managers
Jessica serves as the AAMC’s Alternative Payment team’s policy content lead. In this role, she supports academic medical centers’ involvement in the Bundled Payments for Care Improvement initiative using data and policy analyses to explain financial trends and provide strategic advice regarding episode selection and risk mitigation. Jessica also utilizes the lessons from this work to inform AAMC’s advocacy efforts.
Prior to this, Jessica spent two years as a Health Policy Analyst helping providers to navigate federal ACA regulations and complex Medicare payment policy issues. She also completed graduate internships with the White House Office of Management and Budget’s Health Division and Partners HealthCare’s Finance Department.
Jessica holds an M.S. in Health Policy and Management from the Harvard School of Public Health and a B.A. in Political Science from the University of Richmond.
Jessica serves as the AAMC’s Alternative Payment team’s policy content lead. In this role, she supports academic medical centers’ involvement …
Chris Wilson, JD, MPH, works with healthcare organizations to address strategic issues in an evolving market. He uses his unique combination of consulting and legal experience to design and implement clinical integration initiatives, public policy projects, mergers and acquisitions, and governance strategies. Chris also provides advisory services in the area of healthcare information technology and best practices in the delivery and measurement of evidence-based care for providers.
Chris Wilson, JD, MPH, works with healthcare organizations to address strategic issues in an evolving market. He uses his unique …
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Method of Presentation:
NASBA Field of Study:
Specialized Knowledge and Applications
NY Category of CLE Credit:
Areas of Professional Practice
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Association of American Medical Colleges
About Association of American Medical Colleges
About Pershing Yoakley & Associates, P.C.
As a professional corporation with 30 principals, PYA’s team of resources is more than 175 strong and continually growing. PYA’s people have backgrounds and degrees in nursing, healthcare administration, public health, medicine, economics, finance, management, accounting, tax, and law. Several have extensive prior experience with other healthcare-related organizations, and have specialized training in clinical medicine, clinical coding, and regulatory matters.
Because of PYA’s focus on client service and the highly motivating environment in which it operates, PYA has been very successful in recruiting dedicated and experienced people from national consulting firms and healthcare organizations.
Leveraging the diverse experience and expertise of its people allows PYA to gain a unique perspective on the industry and marketplace. PYA calls it “Vision Beyond the Numbers®.” It uses this perspective to develop tools and methodologies that help its clients identify opportunities and creative solutions where other consultants have only found problems. PYA values most the integrity and objectivity of its people. These values enable PYA to continuously deliver and maintain the quality of service that clients require. Additionally, PYA offers the following compelling reasons for selecting the firm:
- PYA has built one of the largest dedicated healthcare consulting practices in the nation.
- PYA utilizes experienced professionals to achieve superior results in a cost effective and timely manner.
- PYA determines success not by completion of individual projects, but by the ultimate success of its clients. This, combined with PYA’s unmatched knowledge of the strategies and operational goals being implemented today by healthcare providers and businesses, makes it the firm of choice.