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v alue -b aSed c are How Bundled Payments Work According to a report from the Kaiser Family Foundation, bundled payments "establish a total budget for all services provided to a patient receiving a course of treatment for a given clinical condition over a defined period" (Baseman, Boccuti, Moon, Griffin, & Dutta, 2016). Instead of individual providers (or sites) being responsible only for their part in the patient's care and spending, all providers-affiliated by inclusion in the bundled arrangement-share a portion of the total budget. If total expenses for an episode of care are lower than the bundle's target price, affiliated providers may share in the savings; conversely, if costs exceed the bundle's target price, providers may lose money for that episode. The rules for sharing are included in participation agreements and typically cover quality metrics, length of participation, and other terms. Variation exists across bundles. For example, a care bundle for cardiac catheterization might cover charges for the procedure and for 10 days after the procedure, whereas a joint replacement bundle may cover charges for surgery and 90 days after surgery. Payment may even cover "prehabilitation" to improve the patient's strength before surgery. Sources. Baseman, Boccuti, Moon, Griffin, & Dutta (2016); Kaufman, Hall & Associates, LLC. The writing is on the wall. Hospital leaders must focus on bundled payments. Four strategies-obtain needed data, assess data thoroughly, understand what is in the bundle, and engage stakeholders-will be key to success. O B TA I N N E E D E D D ATA Whether working with a commercial payer or CMS, hospitals must obtain cost and quality data when assessing participation opportunities (e.g., selecting episodes of care based on the organization's current performance and ability to reduce costs and improve quality) and monitoring performance as the organization and affiliated providers deliver care and receive payments. Obtaining cost and quality data is not always simple or straightforward, and competency in analytics is essential. Hospitals may seek to partner with payers and self-insured employers, who typically are willing to share historical data. However, hospitals should validate the accuracy of the data and assess the likelihood of meeting performance benchmarks. In a recent blog post, Bahl (2016) describes the major challenge facing hospitals contemplating participation in the CJR program. Although CMS will provide hospitals with detailed historical claims data for patients from the index hospitalization through 90 days after discharge, the "details are provided only concurrently with implementation of the program, giving hospitals little time to organize, analyze, and use these data to identify opportunities and risks" (Bahl, 2016). Bahl also notes several internal sources of data: 315

Table of Contents for the Digital Edition of Journal of Healthcare Management - September/October 2016

Journal of Healthcare Management - September/October 2016
Contents
Interview With Jayne E. Pope, RN, FACHE, CEO of Hill Country Memorial Hospital
How to Find the Ideal Chief Medical Officer
Four Strategies for Succeeding With Bundled Payments
Who Is a Hospital’s “Customer”? Olena Mazurenko, Dina Marie Zemke, and Noelle Lefforge
Vision Statement Quality and Organizational Performance in U.S. Hospitals Rachna Gulati, Osama Mikhail, Robert O. Morgan, and Dean F. Sittig
Maximizing Healthcare Professionals’ Use of New Computer Technologies in a Small, Urban Hospital’s Critical Care Unit Patricia C. Vadillo, Estrellita S. Rojo, Adelaida Garces, and Maria G. Checton
Factors Determining Medical Staff Configurations in Community Health Centers: CEO Perspectives Patricia Pittman, Leah Masselink, Lauren Bade, Bianca Frogner, and Leighton Ku
Journal of Healthcare Management - September/October 2016 - Contents
Journal of Healthcare Management - September/October 2016 - Cover2
Journal of Healthcare Management - September/October 2016 - i
Journal of Healthcare Management - September/October 2016 - ii
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Journal of Healthcare Management - September/October 2016 - Interview With Jayne E. Pope, RN, FACHE, CEO of Hill Country Memorial Hospital
Journal of Healthcare Management - September/October 2016 - 308
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Journal of Healthcare Management - September/October 2016 - 310
Journal of Healthcare Management - September/October 2016 - How to Find the Ideal Chief Medical Officer
Journal of Healthcare Management - September/October 2016 - 312
Journal of Healthcare Management - September/October 2016 - 313
Journal of Healthcare Management - September/October 2016 - Four Strategies for Succeeding With Bundled Payments
Journal of Healthcare Management - September/October 2016 - 315
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Journal of Healthcare Management - September/October 2016 - 317
Journal of Healthcare Management - September/October 2016 - 318
Journal of Healthcare Management - September/October 2016 - Who Is a Hospital’s “Customer”? Olena Mazurenko, Dina Marie Zemke, and Noelle Lefforge
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Journal of Healthcare Management - September/October 2016 - Vision Statement Quality and Organizational Performance in U.S. Hospitals Rachna Gulati, Osama Mikhail, Robert O. Morgan, and Dean F. Sittig
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Journal of Healthcare Management - September/October 2016 - Maximizing Healthcare Professionals’ Use of New Computer Technologies in a Small, Urban Hospital’s Critical Care Unit Patricia C. Vadillo, Estrellita S. Rojo, Adelaida Garces, and Maria G. Checton
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Journal of Healthcare Management - September/October 2016 - Factors Determining Medical Staff Configurations in Community Health Centers: CEO Perspectives Patricia Pittman, Leah Masselink, Lauren Bade, Bianca Frogner, and Leighton Ku
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