Home Forums Discussions General Discussion AMA News 1/11/10 Bundling Inpt Doc Fees

Being tested in 5 markets.
Hospitals get the money from CMS and the hospital pays the doc.
This is to encourage better patient care and keep costs down.
Anyone have experience with this or know about it?

Yes, this has been underway for over a year now. I am not participating, so no firsthand experience, but another very scary idea for us docs who aren't owned by the hospitals. What is the hospital's incentive to play fair? Would withholding the physician's payment be another means to control our clinical decisions?

What is the chance the hospital taking advantage of this: "Sorry doctor, we can't pay you because your length of stay for (insert name of octogenerian patient here) exceeded our projections, based on comparison to our salaried physicians length of stay."

Some early impressions in this article .

Wow John,
You are confirming some of my worse fears about this. I have a good relationship with my little hospital, but I just don't like the idea of even another layer of bureaucracy coming between me and the reimbursement (and the ability to provide quality care).

I am pretty ocd about records in my hospital that still uses paper charts. At times a signature is needed for this or that, and doesn't get done because it is in someone else's box. I don't have any way of knowing until I get a "nasty gram". I can see this being another reason for not paying.

The only good thing I can think of is that maybe the hospital would still have to pay us if the patient hadn't met deductible.

I would probably opt out of any such Faustian pact with the hospital, at least at first. I don't think that the "suits" in hospital, insurance and Medicare boardrooms have any inkling of the distrust that the average patient has for them and their organizations. It would be very simple to thwart their scheme. Unless you are under contract, that is.

This is already happening with Medicare under certain situations:

1) Patient is admitted to nursing home. If, say, I give a Lupron injection, it has to be paid by the NH... it's like pulling teeth. The last case forced me to send my office manager 3 times in order to finally get paid.
2) Now with Hospice in-hospital situations, one's reimbursement has to come out of Hospice's global fee. In this situation it's not as bad in my town since there are at least 3 Hospices trying to get me to do referrals to them. It's still a bad situation, though.

These 2 new policies are part of the reason why I decided last year I decided to begin winding down my oncology practice. It's just so much more difficult to get paid... it's not worth it anymore. I see myself eventually going with a pure outpatient services practice in the not too far off future. <sigh>

Al