• Will New Payment Approach Work?
  • February 3, 2012 | Author: Elliott B. Pollack
  • Law Firm: Pullman & Comley, LLC - Hartford Office
  • A prominent group of orthopedic surgeons has entered into an interesting joint venture with Saint Francis Hospital and Medical Center, the hospital at which they practice.  According to Deirdre Shesgreen's article in ctmirror.org, an online publication, "[t]hey share financial data, analyze complication and readmission rates together, and they've even started billing collectively, at least for a handful of targeted patients."

    The purpose of this experiment, conducted under a pilot program inaugurated by the Centers for Medicare & Medicaid Services (CMS) last year, is to incentivize physicians and hospitals to focus on coordinating care and to develop treatment plans for patients emphasizing effective care rather than episodic encounters.

    Although as of the middle of last year, this pilot program had been focused on only about six patients, the hope is that by working together to understand the nature of the proposed care and the potential for complications, health care professionals will be able to reduce redundancy and excessive care.

    At the same time, basing reimbursement on a predetermined lump sum puts providers in the position of underwriting the costs of "unpredictable outcomes.”  Will "a mutual sense of responsibility and accountability" between institutions and physicians, as one physician characterized it, improve care and save the system money?  Further experience will offer more comprehensive answers to these questions while the Saint Francis orthopedists and the Hospital attempt to negotiate third party payment arrangements with a commercial carrier to include privately insured patients within the uninsured pilot plan.  Assuming some success here, the joint venture may well seek participation in the CMS program too.