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Creating maternal-care bundled payments is tough

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A few hospitals are now using a bundled-payment system like that already used for some orthopedic operations for those on Medicare.

Of course, that model has famously gained popularity among Medicare officials in recent years as the CMS seeks to curb costs while improving outcomes.

Some healthcare experts think that  maternity care may have  perhaps  great bundled-payment potential  But there are only a few pilot programs across the U.S.  And expansion will be complicated.

The biggest obstacle is that because Medicaid is state-federal, unlike Medicare is totally federal, Medicaid can’t force the use of bundled payments as Medicare can. But then establishing bundled payments is intrinsically complicated, although the longterm effect is to simplify treatment and billing by creating orderly, standardized, predictable, evidence-based systems.

Modern Healthcare noted that process design is a big question in setting up maternal bundled-payments systems.

“What should trigger the bundle? Does it begin with prenatal care? With delivery? When should it end, and whom should it include? How should providers—primarily hospitals, but sometimes birth centers—take on financial risk? Some models allow high-risk mothers, such as those who are obese or have AIDS, or high-risk babies; others include only low-risk pregnancies.”

And how do you establish standardized systems? As the publication reports: “{O}ne-off contracts between providers and payers {have} proved tedious and unreliable.”

Modern Healthcare notes that U.S. maternal healthcare is not particularly good when compared to many other nations, and implies that a bundled-payment approach might improve things.”

“Bundling payments may help recalibrate maternity care to focus on what’s best for the mother and child, smooth out these imbalances in costs and make prices more predictable, according to the model’s boosters.”

But it will be a much tougher to get going than Medicare bundled payments, which is being extended into cardiac and other care from orthopedics.

To read the Modern Healthcare piece, please hit this link.

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