Question: Our hospital is developing bundled payment models for various types of care. I’d like to develop a structure for roles and responsibilities as we move through the process. Who are the main players within finance and other departments who are typically involved in developing bundled payments? What stakeholders should be included in decision making and reporting?
Answer 1: Clearly, there needs to be leadership from finance. However, the most critical role is one of clinical financial analysis. Business analytics in the realm of clinical process mapping, and the ability to identify drivers of cost and performance variation, is at the core of this effort.
Here’s my suggested team:
- Operations leader (SME)
- Physician leader (SME)
- Finance leadership
- Clinical analytics (quality/data management)
- Decision support (financial analytics)
- Revenue cycle management
- Coding and clinical documentation
- IT support
- Electronic health record support
This question was answered by: Curtis H. Bernstein, CHFP, CPA/ABV, ASA, CVA, principal, Pinnacle Healthcare Consulting, and a member of HFMA’s Colorado Chapter.
Answer 2: If the hospital is the at-risk provider in the bundle, the players may vary from those participating in a bundle under fee for service.
Convener. If you are the at-risk provider and depending on the number of bundled items, appoint a convener to handle the claims data and assess the distribution of savings.
Cost accountant. Cost accounting is essential. You must understand your cost of care, but also have access to payment information for other providers of care in the bundle.
Contracting. Involvement by someone who is familiar with what is included in or excluded from bundles is imperative.
Financial analyst. Determining the impact of volume and potential shifts in revenue patterns is key to understanding the full impact of implementing bundled payments. Loss of market share may occur that might otherwise not be considered.
Revenue cycle. Depending on the complexity of the organization, revenue cycle leaders should provide input on the revenue and service impacted by bundles.
Ultimately, the team depends on the size, nature, and extent of the organization.
This question was answered by: David A. Williams, FHFMA, CPA, partner, Horne LLP, and a member of HFMA’s Mississippi Chapter.
Answer 3: We are also starting to develop bundled payment models, and we are facing that exact question. Who plays what role? Our managed care contracting group within finance has taken the lead, with outside consulting support, but we haven’t agreed to other roles. Strategy, administrative, quality, and clinical leadership all have a stake in this, but we don’t have clear decision-making structures. It’s an important issue.
This question was answered by: Ruth Lande, senior vice president, patient revenues, Memorial Sloan-Kettering Cancer Center, and a member of HFMA’s Metropolitan New York Chapter.
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