ASCs and other practices have several factors to consider before diving into bundled payments, according to a presentation Health Business Navigator President Penny Notes gave at the Medical Group Management Association conference in Anaheim, Calif.
Here's what you should know:
1. Know how much risk you are willing to take. When diving into a bundled payment, there is always some amount of downside risk, Ms. Noyes said. Some bundles aim to mitigate this risk by allowing providers to choose which patients are included in the bundle. However, Ms. Noyes said many payers may steer away from this practice of low-risk bundles in the future.
2. Be prepared to negotiate the level of risk. Ms. Noyes said providers should consider reinsurance agreements if applicable. All bundlers should ensure a payer is not making them 100 percent responsible for services a patient obtained over a certain amount of time. If ASCs or providers do not ascertain this, they could pay for services rendered outside the defined episode of care.
3. The legwork may well be worth it. With potential risk and the many moving parts to consider in a bundle, many ASCs and other practices wonder if all the work is worth it. However, Ms. Noyes said bundlers can accrue rewards if they succeed in keeping costs below the negotiated bundled rate.
She said, "If you can come up with a price that's smaller than that but you do it so efficiently that makes you more margin than you did before, that's the impetus for doing this. If you do a really good job, payers might be steering most of these to you."