Bundling…Will we survive捆绑……我会活下来

1、bundling.will we survive?thomas e. amitrano bsn, mpa, rnbundling.will we survive?bundling will we survive ?a bit of historynin 1972 congress enacted legislation to create a way to finance end stage renal disease (esrd)nin 2008 congress passed the medical modernization act (mma) as well as the medica

2、re improvements for patients and providers act (mippa) these acts required the centers for medicare and medicaid services (cms) to look at the elimination of payments that were separately paid for dialysis services and drugs.nbundling is the solution cms has proposedestimated point prevalent esrd pa

3、tients figure 11.3 (volume 2) december 31 point prevalent esrd patients; non-medicare status determined from payor sequence. usrds 2009 adrtotal medicare dollars spent on esrd, by type of service figure 11.5 (volume 2) esrd spending obtained from medicare esrd claims, & includes all medicare as

4、primary payor claims as well as amounts paid by medicare as secondary payor.usdrs 2009 adrtotal medicare esrd expenditures, by modality figure 11.6 (volume 2) period prevalent esrd patients. modalities determined using model 1 methodology. includes medicare paid claims for esrd patients, starting at

5、 first esrd service date & continuing until death or the end of the study period. patients with medicare as secondary payor are included.usrds 2009 adrtotal medicare spending on injectables figure 11.13 (volume 2) period prevalent dialysis patients. esas: erythropoiesis stimulating agents.usrds

6、2009 adrwhy change?nin a separately billable system certain services are billed for as “composite” and others are billed for as “separately billable”. this system left some question as to the profit margin some dialysis units reported. if all services were equal why did some units make more money th

7、an others?proposed* changesn payment will be on a per treatment basisn all drugs and labs will be included all renal service oral drugs including phosphorus binders all labs ordered by nephrologists or othersn reimbursement would “trim 2% of the estimated payments that would have been made in 2011 u

8、nder the previous payment system”n no adjustment for race/ethnicityn wage index adjustments are likelyproposed* changes (cont)n units will have the option of easing in over 4 years or going 100% at one timen the mathproblemsnold data may have been used cost reports etc. in some cases are datednno co

9、nsideration of inflationncertain areas of the country will get less reimbursement for the same servicesnpotential for decreased care based on decreased reimbursement existsnew quality indicators on or after july 1,2010nkt/v must be reported for both hd and pdnaccess type must be reported for hd worr

10、ies/ concernsnwill practice be a result of paymentnwill quality and performance improvement changenwill hospitalizations be decreased or shortened for the wrong reasonsnwill units close and leave gaps in servicenwill we have to do more with lessour role in bundlingnmaintain high standards of carenen

11、courage each patient to maintain their optimal level of healthneducate patients to be proactive and preventative not reactive regarding their healthnwork diligently to prevent patient illnessour role in bundling (cont)naccurately document all information on all forms. co morbid conditions are import

12、ant nlook for ways to improve efficiencynmake patient safety and well being a major priority and goal decrease hospitalizations decrease infections manage medications our role in bundling (cont)nremain in close communication with the hospital dialysis units maintain continuity thru the continuum of

13、health/illnessndevelop policies and practices that are evidence based to ensure high standardsn“no missed treatment” philosophy offer alternate times/daysplanning for changenassess current practices and critically analyze the ability of the practice to survivendevelop strategies that promote patient

14、 well being across the continuum of healthnincorporate evidence based practice into policies and practicesplanning for change (cont)nanalyze qapi data for trends and patternsplanning for change (cont)nread, read, readnactively engage your colleagues in a spirit of changesummarynbundling is going to happen in so