Get out in front of bundled payments, Seibels says

Friday, April 3, 2015

LAS VEGAS – CMS’s plan to use bundled payments isn’t popular, but the initiative could, ultimately, help HME providers show their worth as cost-savers, says Emmet Seibels, who spoke at Medtrade Spring last week. 

“DME gets seen as a cost,” said Seibel, president of Verus Healthcare, a healthcare supply company based in Franklin, Tenn. “DME produces great results. We need to flip the perception of DME from a cost center.”

CMS in October released a final rule detailing its plans to use bundled payments for CPAP devices and power wheelchairs, as well as for accessories, supplies, maintenance and repairs. The agency has provided few details on the initiative, other than that it would begin a demo on Jan. 1, 2016, in 12 non-bid areas with populations of at least 250,000 and with at least 20,000 Medicare beneficiaries.

Bundled payments open the door for providers to concentrate on patient health management, a focus that could help them reduce overall healthcare costs, says Seibels. 

“The focus shifts from how many masks and supplies we can ship and bill, to coaching and counseling,” he said.

Providers should leverage technology that allows them to collect and analyze compliance data and improve outreach to better manage their patients, says Seibels.

“The name of the game is compliance rates,” he said.

The truth is, bundled payments may be an inevitability, Seibels says. Other insurers are also looking to this pricing methodology as a way to reduce cost and improve outcomes, he said.

“Talk to them about the shared financial risk,” Seibels said. “I take the risk if they are noncompliant, but if they are compliant, we distribute the risk more evenly.”

There’s also the issue of bundled payments being used for additional products down the road. CMS had also initially considered using the payment methodology for hospital beds, enteral nutrition, oxygen and respiratory assist devices, but it has backed off from that—for now.

“They are testing it on CPAP and power wheelchairs, but it could grow to include more DME,” said Seibels.