Earlier this month, CMS announced it would be cutting the number of participants in its Comprehensive Joint Replacement bundle payment program and cancelling cardiac and hip fracture episodes of care that were slated to begin in January. It seems so counter-intuitive. After all, the purpose of these programs is to drive alignment between facility and physician, correcting one of the fundamental flaw in US Healthcare of separately reimbursing facilities and surgeons. But will correcting it really have the impact we are looking for; which is to say drive better value?
Whether surgeons and hospitals have to share a single payment for an episode of care, or they continue to get paid separately, it is up to us to find the best value for ourselves. While the pundits have been waxing prophetic on the merits and detriments of bundled payments, a study aiming to understand how much “shopping” is being done by patients in need of care was released. It’s findings pointed to the fact that only 3% of patients shopped around the best rate for their care. The study goes on to cite transparency as the main driver for this – that if pricing was easier to attain, more patients would shop around to find better value.
Twenty years ago we didn’t shop for healthcare services. Shopping consisted of one question to both physician and facility: Do you accept my insurance? End of story. Now, we are beginning to shoulder more and more of our healthcare costs. It’s a painful yet necessary transition. The only silver-lining to this cloud is that the more painful out of pocket costs become, the more patients will shop. The more patients shop, the greater transparency and competition becomes to provide care. Competition breeds value.
Solutions to our healthcare cost woes so far have focused on controlling how much reimbursement can be awarded for delivering care. What we are just starting to see now, regardless of any programs, are patients choosing services based on their wallet, not just simply the in-network status of providers. The answer to our greatest challenge, perhaps, is bundling patient and consumer behavior, not bundling physician and facility fees.