Question

please help me answer this!

Your organization has chosen to implement a bundled payment model for your cardiac surgery patients, so the health care organization is responsible for an entire episode of care. What problems/challenges do you see? What benefits are immediately available? How do you market this model of payment to your board and other key stakeholders? How do bundled payments fit into our reimbursement system?  Defend your answers and explain the pros and cons of bundled payments.Think about this from multiple viewpoints:

• the provider (physician, nurse practitioner)
• the insurer (payor)
• the patient
• the administrator
• the regulator

Answer 1

The bundled payment system is the payment system in which the payment for a specific health care service is provided in a single payment. The price of all the costs incurred for the cardiac surgery has been clubbed and the payment is provided as a single settlement.

The financial risks which can impact the health care service provider is the challenge which can be raised through the bundled payment. Since the health care provision under this system is cost effective and standardized the patients may not receive proper treatment if there is an increase in the cost of the health care. Since the cardiac surgery is a critical treatment any compromise can be life threatening. For the surgeries which are highly risky the costs cannot be controlled by the provider which can yield challenges for the provider. Another challenge is the technological challenge which can be managed through implementing higher degree of control.

The bundled payment can benefit the organization as it could provide standardization in its health care service provision. The data maintenance and accessing would be much easier. Increase in the provider communication, optimization in the provision of the treatment etc are other benefits for the service providers. The payer can also make the payment collectively which reduces their documentation costs and time. The patients can also benefit this through getting a clear cut idea about the expenses which can incur for the treatment.

The bundled payment can be marketed effectively among the share holders and the marketers. Since this payment system is attractive, collective, etc the health care patients can get attracted and can prefer our health care provision. Increase in the number of patients can increase profit margin and loyalty and hence can attract the share holders.

In our traditional reimbursement system the payers or the insurer would reimburse the physician, anesthesiologist, etc separately for the services they have provided. According to the bundled payment system, the reimbursement is provided collectively. The bundled payment is performed based on the historical costs incurred in the cardiac surgeries. The costs which come beyond the pre arranged reimbursement have to be bear by the health care providers itself. Hence this payment will enable the service provider to provide a cost effective and standardized health care service.