Bundled payment is definitely coming, Dr. Rissmiller says, and will fuel the move to inpatient-outpatient partnerships.
“A lot of this work is in preparation for ACOs and bundled payments, even if the new models are not yet dominant in the marketplace.”
Bundling payment for an episode of care, including the hospital stay and all of the post-acute follow-up, will be a game-changer, Dr. Wilborn adds. CMS is now testing bundled payment models and, by 2017, he says they will be an established fact in nursing homes, with half of their reimbursement coming from some kind of bundle.
James Tollman, MD, FHM, heads a small HM group, Essex Inpatient Physicians, which he started in 2007 in Boxford, Mass. Essex includes full- and part-time physicians and physician extenders and has contracts with several hospitals, but Dr. Tollman estimates that 95% of the practice is in post-acute care.
“For us, as a small group in the current environment, it’s a good idea to diversify,” Dr. Tollman says. “It’s important to be flexible and have a foot in many venues.
“I view myself as a hospitalist by personality and history,” he adds. But experience working in post-acute care enables physicians to view the hospital in perspective—as part of the larger continuum of care and not the center of the universe.
Dr. Tollman says risk contracts with ACOs are the new frontier for hospitalists in post-acute care.
“Who manages the money is an important question,” he says. “The quality metrics are still poorly aligned with what the SNF-ist does. Right now, we’re entering contracts with three different ACO-type exchanges. None of them have really figured out what we are about, and we don’t have much leverage yet.”
Larry Beresford is a freelance writer in Alameda, Calif.
References
- Society of Hospital Medicine. 2014 State of Hospital Medicine report. Philadelphia, Pa.; Society of Hospital Medicine; 2014.
- Firth S. House panel considers medicare reform for post-acute care. Medpage Today. April 18, 2015. Accessed June 10, 2015.