Making it easier
Holdco hospitals approved for ‘billing bundling’ for Medicare
by Al Sullivan
Reporter staff writer
Mar 06, 2013 | 3895 views | 0 0 comments | 7 7 recommendations | email to a friend | print
WORKING OUT THE DETAILS -- Dr. Norma Jean-Francosis, Transition in Care director, and Dr. Vijayant Singh were instrumental in getting a new pilot program.
WORKING OUT THE DETAILS -- Dr. Norma Jean-Francosis, Transition in Care director, and Dr. Vijayant Singh were instrumental in getting a new pilot program.
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Accepted into a pilot program that could bring down the costs of repeated treatments for the same medical condition, Hudson Holdco – which operates Christ Hospital, Bayonne Medical Center, and Hoboken University Medical Center – will begin the program by year’s end.

Called Bundling, the pilot program combines all the services related to a single event into one payment, and keeps payments lower by ensuring that Medicare patients can get higher quality services at lower costs, particularly if they are being treated for congestive heart failure or chronic obstructive pulmonary disease.

The program forces hospitals and doctors to better coordinate their care and to eliminate unnecessary costs and duplicate services, while still improving the quality of care to the patient.

Dr. Mark Spektor, CEO of Bayonne Medical Center, said the three hospitals have been selected by the Centers for Medicare and Medicaid Services (CMS) for inclusion in the program, which was started in 2009.

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“These are patients that have a higher risk of readmission.” – Dr. Mark Spektor

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The program will specifically affect Medicare patients being treated for certain conditions.

“These are patients that have a higher risk of readmission,” Spektor said.

Many types of services could be bundled, from inpatient and outpatient services to rehabilitation, Spektor said.

Dr. Norma Jean-Francosis, transition in care director, said the hospitals are still working on some of the details as to the length of time that this will involve, including whether bills would be bundled for episodes within 30, 60, or 90 days. Regardless, the bundling will reduce costs to the government.

Cutting costs

Jean-Francois said in these areas of care, doctors frequently see patients that are discharged, only to return. Combined with the hospital’s already established readmission reduction program, the frequency of readmission may be cut back as well, since the readmission reduction program seems to dovetail with the pilot bundling program.

Currently, Holdco hospitals provide this service for patients dealing with Congestive heart failure (CHF), Chronic obstructive pulmonary disease (COPD), pneumonia, and Myocardial infarction (MI)

The Readmission Reduction Program was designed to provide continuity of care to high risk patients as they transition from the hospital setting to their home setting.

RRP follows patients through their medical experience by providing follow up care even in the home setting to make sure patients are getting the care they need, Jean-Francois said, and this will allow some of these services to also be bundled.

Bayonne Medical Center has improved in its congestive heart failure results, going from a ranking as one of the worst in the state prior to being purchased in 2008, to one of the top 10.

“Prior to this, we had one of the worst death rates in the state when it came to congestive heart failure,” Spektor said. “We now have a good basics program.”

Jean-Francois said the followup care in these areas allows the hospital to better manage resources while at the same time makes certain that patients are getting their proper care, including taking of medication in the home setting.

“We follow patients to see that they get the care they need,” she said.

The bundling program helps make billing issues less burdensome and confusing since the costs for services associated with various services come in one bill instead of a number covering a series of admissions or after services.

“We expect bundling to save money and improve the quality of care,” Spektor said.

Dr. Vijayant Singh, chief medical officer at BMC, said bundling has two distinct advantages. First it allows for care to be continuous during and after a hospital stay, reducing the fragmentation of billing that seems to create the illusion that these are separate and distinct, when they are all part of treatment for a single episode.

And combined with the discharge program, doctors have a better way to maintain care, following up on discharge instructions their patients may not be following on their own or because they’re confused about instruction involving diet and medication.

“Patients may also have more questions they may have forgotten to ask,” Singh said.

These programs, when taken together, help reduce Emergency Room visits and readmissions, as well as cut the cost the government pays in Medicare for those patients most likely to be readmitted.

To qualify for the pilot program, Spektor said, the staff went through a lengthy application process that including providing data and multiple applications over a few months.

Al Sullivan may be reached at asullivan@hudsonreporter.com.

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