News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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New CMS Pilot Intends to Test Viability of a Universal Bundled-Payment Model for Inpatient Care

Nearly 500 healthcare organizations nationwide to participate in payment bundling for 48 Conditions

Medicare’s largest bundled reimbursement project to date is now launching. Clinical laboratory executives and pathologists are watching for clues as to how these bundled payment arrangements will compensate the clinical laboratory testing done on behalf of patients whose care is covered by this latest Medicare initiative.

The Centers for Medicare & Medicaid Services (CMS) will commence implementation of Phase 1 of the Bundled Payments for Care Improvement Initiative. This will be a three-year project that will test the viability of a universal bundled payment system to improve coordination and quality of care and lower costs. It is also the largest bundled-payment pilot to date, with nearly 500 participants, according to a story published by Healthcare Finance News.

One major goal of this Medicare project is to begin moving providers from the current fee-for-payment model to a single, lump-sum payment model. This would be true for all Medicare Part A and Part B services provided during one episode of care. (more…)

CALPERS Saves $15 Million in Health Premiums Because Proactive Care Reduced Hospital Inpatient Admissions

Clinical laboratories and pathology groups may need to re-strategize should hospital inpatient admission rates begin declining as a result of proactive clinical care programs

More hospitals are ramping up their services in proactive outpatient care. The goal is to reduce hospital admissions and curb costs. The challenge is that fewer admissions and shorter stays mean a drop in hospital revenues. For the hospitals’ clinical laboratories, it also means less inpatient lab test volumes.

Hospitals are doing this in response to changes in reimbursement models specifically designed to incentivize providers to keep people out of hospitals. Of all sites that deliver patient care, hospitals account for the greatest share of the nation’s healthcare dollar. This makes them a prime target for cost cutting, noted a recent story in Modern Healthcare (MH).
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