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Challenges Physicians Face with Healthcare Bundled Payments

Added: (Wed May 01 2019)

Pressbox (Press Release) - Many physicians out there are struggling with healthcare bundled payments. Even though this payment model was expected to bring highest quality care and improved patient outcomes.

Here are some of the challenges that it is posing for healthcare providers:
• Scaling up or achieving economies of scale has become a challenge under bundled payments. Scaling is very important for providers in order to seek financial gains. They generate profit from treating high volumes of the conditions or procedures that have been targeted in the bundled payment model because they receive a fixed payment per bundled patient. However, providers are struggling to achieve the right scale of procedures performed. Even scaling the number of locations or facilities has become a hurdle. If they don’t up their patient volumes and have enough facilities across the care continuum to manage patients, they will fail to realize financial success.
• Managing healthcare costs has become the second big challenge for providers under bundled payment model. Providers not only have to cultivate post-acute care partnerships in order to control costs outside their facilities but they also have to manage unexpected spending within patient groups and organization. There are situations when using a bundle may not be the right thing to do because factors influencing differences in cost among patients are things that physicians don’t get to control.
• Third challenge that physicians face under bundle payment model is of controlling costs by leveraging post-acute care partnerships. A physicians’ financial accountability under this payment model isn’t just limited to only the time he/she is spending at the practice or the hospital setting. It is also limited to the entire care episode. Therefore, this cost can cover either up to 90 days in a post-discharge facility or just a few days in the hospital. To address this challenge, it is necessary that the hospital is partnering with high-value post-acute care facilities.
According to The American Journal of Managed Care, physicians may find this payment model challenging since there may be costs related to a patient’s treatment that are not under their control. Under this payment system, physicians can even get penalized when it comes to medical costs that cannot be avoided.
Even the possibility of healthcare underuse is a challenge among bundled payments. It can lead physicians or hospital workers to underuse some of the required diagnostics or treatments.

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