Personal Responsibility: The Key to Controlling Health Care Costs

          I recently attended an expert panel discussion entitled, “Handling Bundled Payments.” For anyone unfamiliar with the bundled payment system, it is defined as the reimbursement to health care providers, "on the basis of expected costs for clinically-defined episodes of care.” Costs (and risks) are shared based upon quality outcomes such as returns to acute care after service. It is a departure from the traditional “fee-for-service” reimbursement model in which a provider is paid per service rendered, regardless of outcome.
          The bundled payment system basically puts all providers within the bundle into one boat—they either sink or swim—and if one fails they all suffer the consequences. Conversely, if they all succeed, all reap the cost benefits. The ultimate goal is to keep costs low and patient quality outcomes high.
          Currently, bundled payment options are focused on joint replacement. However, in July 2016, the Centers for Medicare and Medicaid Services (CMS) announced three new bundles directed at cardiovascular care procedures, including acute myocardial infarction, coronary artery bypass graft and hip/ femur fractures. This new model was tentatively set to go into effect on July 1, 2017.
          The expert panel discussion revolved around how to maximize patient outcomes, minimize risk and prevent patients from returning to the hospital.
Several recommendations surfaced:

1. Manage pre and post-surgical risk;
2. Provide patient education;
3. Assign navigators to follow the patient after discharge;
4. Refer to preferred providers within the network where possible (Skilled Nursing/Home Care);
5. Ensure clear communication at transitions of care;

          As the discussion progressed, it was clear that risk management was key and revolved around ensuring that each provider took full responsibility for delivering the highest quality of care.
          There is something fundamentally wrong with this equation--
HOSPITAL + SKILLED NURSING FACILITY + HOME CARE AGENCY= SUCCESS is missing an essential factor--THE PATIENT! 
 
          The fact that the Medicare covered patient who goes home and does not follow instructions bears no financial responsibility in the equation whatsoever is absurd. The fact that the patient’s own irresponsible choices result in substantive costs for the providers significantly reduces the effectiveness of the bundled program in reducing costs.
          Unless and until we include an element of patient responsibility into the bundle, costs will never effectively be controlled.