Researchers and wonks are talking about the idea of taking a hot acute health care concept — payment bundling — and applying the idea to long-term care (LTC) services.
Some people love the payment bundling idea; some people simply mutter “capitation” and “1990s” and change the subject.
It’s hard to know whether a health payment strategy will really work until providers and insurers try the strategy in the real world, on a large scale, and check to see if it works. Impeccable logic is no match for field work.
But it seems as if, if creating care teams for older Americans and paying those teams as teams did work, a well-designed, well-implemented payment bundling approach could make writing private long-term care insurance (LTCI) more profitable, by reducing the incidence of claims and reducing the intensity of the care that insureds who do file claims need.
A team of researchers led by Mary Naylor, a gerontologist at the University of Pennsylvania nursing school, talks about strategies for elder care payment bundling in a commentary that appears behind a pay wall this month in Health Affairs, an academic journal that covers health finance and health care delivery.
The drafters of the Patient Protection and Affordable Care Act of 2010 (PPACA) tried to do something about the mishmash of care many Americans get by including the Hospital Readmissions Reduction Program. The program is supposed to impose a penalty on hospitals with high percentages of patients who come back to the hospital within 30 days of charge.
The penalty is set to start 1% in federal fiscal year 2013, which starts Oct. 1, and rise to 3% in 2015.
PPACA also created acute care payment bundling pilot programs.
Naylor and her colleagues say they wish PPACA drafters had thought harder about how the care coordination programs might affect the kinds of frail elderly adults who need LTC services.
The readmissions reduction program sounds great on paper, for example, but some hospitals might cut readmissions rates the nasty way: by shutting out desperately ill patients.