Bundled Payments and the Case Management Department in Hospitals

Why Should You Attend:

In this session Ms. Cunningham will introduce the concept of bundled payments, as well as the roles of each case management department staff member in this initiative. Areas of focus will be the role of the case management leader in collaboration with other leaders, as well as the roles of the RN case manager and the social work case manager in ensuring optimal outcomes for both financial and clinical outcomes.

She will also discuss best practices for developing steps to ensure collaboration of all key stakeholder disciplines, both internal and external. Effective alignment with both physicians, physician advisor's and post-acute care providers will be reviewed. Discussed also will be case management outcomes that will positively affect the hospital’s bundled payment scorecard.

Attend this webinar to understand the bundled payments, ensuring optimal processes, auditing effectiveness and roles of the case management department’s in their impact on outcomes.

Areas Covered in the Webinar:

• Bundled payment history and purpose
• Bundled payment elements: mandatory and optional
• Case management’s role in the hospital’s bundled payment initiative
• Quality metrics of bundled payments
• Financial metrics of bundled payments
• Challenges of bundled payments
• Strategies for effective bundled payment initiatives: hospital and case management department strategies
• Case management department roles
• Aligning with physicians and other internal providers
• Aligning with post-acute care
• Bundled payment successes

Who Will Benefit:

• RN case managers
• Case Management Leader
• Social Work Case Manager
• Physician Advisors

Beverly Cunningham
Consultant, Case Management Concepts LLC

Bev Cunningham, MS, RN, ACM is a founding partner of Case Management Concepts, LLC. She has a 25-year deep working knowledge of case management with specific expertise in denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process. Bev is also a certified case manager with the American Case Management Association. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital.

She has co-authored a book for hospital case managers—Core Skills for Hospital Case Managers and has written the utilization management chapter in the past two editions of CMSA’s book, Core Curriculum for Case management.

Topic Background:

As the Center for Medicare and Medicaid Services have transitioned to paying for value, rather than paying for volume, they have also challenged providers to be strategic in cutting costs. One aspect of cost cutting has been the focus of expecting a provider to align and collaboration with other care providers to decrease costs and improve quality outcomes. This cost cutting focus offered hospitals the opportunity to volunteer their involvement in having payments bundled to them—and in turn, using those bundled payments to reimburse others in the continuum for their part of care provision.

Under the CMS bundled payment model, CMS issues a lump sum, or a “bundled” payment, to the hospital delivering an episode of care during a specific time period. The bundled payment would then be distributed by the hospital to other care providers, which may include physicians, and post-acute care providers. Because a bundled payment is smaller than the sum of individual payments to providers, providers can succeed only by reducing costs and delivering a more efficient episode of care. While ensuring cost effective care, a second expectation of the bundled payment methodology is that quality care metrics are met.

CMS’s first and optional Bundled Payment for Care Improvement (BPCI) Initiative, aimed at increased coordination among providers treating Medicare beneficiaries. Following the optional bundled payment initiative was the mandatory bundled payment model, which included Comprehensive Care for Joint Replacement (CJR) and began in 2016.

Other payers have now partnered with providers in similar bundled payment programs. Most recently the bundled payment program has been expanded to include many more optional diagnoses and procedures. This comprehensive approach to increased risk at the hospital level has required active involvement of case management departments to align with other hospital providers and post-acute care providers in providing quality and cost-effective care.

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