The PROMETHEUS Bundled Payment Experiment: Slow Start Shows Problems In Implementing New Payment Models

Abstract

Fee-for-service payment is blamed for many of the problems observed in the US health care system. One of the leading alternative payment models proposed in the Affordable Care Act of 2010 is bundled payment, which provides payment for all of the care a patient needs over the course of a defined clinical episode, instead of paying for each discrete service. We evaluated the initial "road test" of PROMETHEUS Payment, one of several bundled payment pilot projects. The project has faced substantial implementation challenges, and none of the three pilot sites had executed contracts or made bundled payments as of May 2011. The pilots have taken longer to set up than expected, primarily because of the complexity of the payment model and the fact that it builds on the existing fee-for-service payment system and other complexities of health care. Participants continue to see promise and value in the bundled payment model, but the pilot results suggest that the desired benefits of this and other payment reforms may take time and considerable effort to materialize.

What Drives Variation in Episode-of-care Payments for Primary TKA? An Analysis of Medicare Administrative Data

“…The decision to exclude low-volume hospitals is consistent with statistical principles used by the CMS and others when evaluating hospital performance-in particular, that small sample sizes of lower-volume hospitals are insufficient for valid estimates of performance [21,22]. For each patient who received a primary elective TKA in one of our study hospitals, we created a longitudinal record extending from 30 days before admission until 90 days after surgery; thus, the total episode of care for each patient extended for a full 120 days in accordance with current proposals for episode-of-care payments using the five data files described previously [9,18,24].…”

Emerging Lessons From Regional and State Innovation in Value‐Based Payment Reform: Balancing Collaboration and Disruptive Innovation

“…10 Blue Shield of California joined with Dignity Health and Hill Physicians to offer an ACO under a global payment system for enrollees in the California Public Employees' Retirement System (CalPERS). 18 Partner organizations agreed to share both the upside and downside financial risks.…”

“…Furthermore, stakeholders may have different perceptions of the proposed changes, even those on which they agree. 10 Concerns about potential violations of antitrust regulation also complicate collaboration among competitors. 30 Conversely, strong payer-provider relationships appear to facilitate the implementation of payment and system changes.…”

“…Successful payment reform requires providers and payers to collaborate and coordinate and may be impeded by the many contentious and competitive relationships among stakeholders. 10,23,28,29 For example, bundled or global payments require that stakeholders agree on the type of payment and means of sharing risk and payment, as well as the metrics for measuring performance. Concerns about potential financial losses and inequitable sharing of risk may keep them from reaching a consensus.…”

Using Digital Technology to Engage and Communicate with Patients: A Survey of Patient Attitudes

“…[1][2][3][4][5][6][7][8][9][10][11] A critical component of population management requires proactive, regular interaction between patients and the clinician or clinical team-engagement and communication that will take place outside the traditional face-to-face encounter. [12][13][14][15][16][17][18] Outreach outside of physician visits, for example, has been shown to improve colorectal cancer screening, 19 increase influenza vaccination, 20,21 reduce medical costs and hospitalizations, 22 and improve care and health outcomes for patients with chronic care conditions.…”