Sunday, November 20, 2011

Will Bundled Care Save Health System a Bundle?

This will save you a bundle.

Common Marketing Premise and Promise

November 20, 2011 - In his NYT Op-Ed today, Ezekiel Emanuel, MD, former Obama advisor and now vice-provost and professor at Penn, argues that bundled payments for episodes of care, e.g. diabetes, heart failure, and hip replacements, will save a bundle for taxpayers and patients.

Since 2009, he reports, Medicare has bundled payment for 37 cardiovascular and orthopedic procedures, with preliminary data indicating savings of 10% and improved quality of care. Therefore, we should “ make the program mandatory for all hospitals beginning January 1, 2013, eliminating fee-for-service for the procedures.”

Fee-for-service, Dr. Emanuel maintains, incentivizes specialists to give more services than needed in a fragmented and inefficient manner, while bundled payment delivered by coordinated groups would be more efficient and keep patients healthier. Besides, specialists and hospitals, “ lose money if they keep the chronically ill healthy,” as if greed drives specialists to do what they do.

If only, he pleads, we could roll all caregiver payments into one bundle to pay all health care players into one neat, all- encompassing bundle, we could prevent events like 20% hospital; readmissions of chronically ill patients from occurring.

Not so fast, Dr. Emanuel, these readmissions are usually very sick patients, suffering from chronic irreversible illnesses developed over a lifetime, not curable by one hospital admission.

Furthermore, many revert to old behavioral and dietary habits that got them into the hospital in the first place, and 40% of them do not fill or take their prescriptions. Complications consequently happen under the best of payment models or treatment conditions when you’re old, sick, and forgetfull

Changing the payment system isn’t going to restore them to health or prevent readmissions.

What patients need, according to Emanuel, is “high touch medicine” and “concierge medicine” offered up by teams of caregivers anticipating every human need, thereby preventing complications . Politician say we need, he says, “a health care system rather than a sick care system. They are right, and high touch medicine and bundled payments are the best ways to catalyze that change.”

Maybe. But, in my opinion, Emanuel mischaracterizes “concierge medicine,” and “high touch medicine, “which iin the eyes of doctors, is more about individual doctors devoting more time with individual patients and escaping the bureaucratic restraints of government medicine.

As for saving money, it has yet to be proven that herding patients, doctors, and hospitals into organizations offering bundle care saves money.

Tweet: Read Doctor Ezekiel Emanuel’s NYT Op-Ed piece ,“Saving by the Bundle,” to learn how Obamacare proposes to save money and improve care (11/20).

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