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Response to third peer DQ two

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response three DQ two: In 2010, the Affordable Care Act (ACA) changed the way in which providers looked at care reimbursement (Haney, 2010). The ACA sought ways in which to “intertwine the quality of care with the cost of care” (Haney, 2010). A large focus was placed on the duplicity of care and the frivolous spending on unneeded medical procedures because of the fragmented nature of the system without a singular responsible party (Haney, 2010). One solution that was introduced to alleviate this fragmentation is the bundled payment model of care reimbursement (LaPointe, 2016).

The bundle payment model can be defined as a reimbursement model in which “providers and/or healthcare facilities are paid a single payment for all the services performed to treat a patient undergoing a specific episode of care. An “episode of care” is the care delivery process for a certain condition or care delivered within a defined period of time” (LaPointe, 2016). This system is one of risk and reward. The risk is that if the provider/facility goes over the bundled payment reimbursement price the provider/facility is responsible for the difference in cost/reimbursement (LaPointe, 2016). The reward of participating in this type of reimbursement model is that if the provider/facility is able to treat the patient without exhausting the bundled payment they are able to keep the excess (LaPointe, 2016). The intended outcome of this payment model is the standardization of cost and the increase in effective care decisions (LaPointe). The thought is that the decision maker for the case will pay more atention to the duplication of efforts and waste as well as verifying all healthcare members are on the same page working in the same direction thus benefiting the patient.

Does anyone know of or can see a complication that may arise due to this type of reimbursement method?

Haney, Cynthia. (2010). New care delivery models in health system reform: Opportunities for nurses and their patients. Retrieved from https://www.nursingworld.org/~4af0e8/globalassets/docs/ana/ethics/new-delivery-models—final—haney—6-9-10-1532.pdf

LaPointe, Jacqueline. (2016). Understanding the basics of bundled payments in healthcare. Retrieved from https://revcycleintelligence.com/news/understanding-the-basics-of-bundled-payments-in-healthcare