Bundled payments are becoming a popular option for patients who require expensive, complex medical procedures that often involve more than one doctor and treatment. But although these plans have been hailed as “win-win-win” situations for all parties involved—doctor, patient, and clinic—healthcare lawyers in Florida, Georgia, New York and New Jersey say that doctors who are asked to participate in bundled payment plans should carefully evaluate the choice they are presented. They should also consider the pros, cons, and legal implications of using the bundled payment plan.
In a bundled payment, the clinic offers a fixed price per episode of care to its patients. This price incorporates the fee for the surgeon, anesthesiologist, and hospital facility, and covers any costs for implants or other devices used during surgery. These arrangements provide patients who could not otherwise afford it with high-quality care. By offering bundled payment plans, with the negotiated price, hospitals and clinics are lowering costs for astronomically high procedures, and providing expert care and treatment, making surgery and other medical needs more affordable for patients and their insurance providers.
For employers who offer health benefits, the bundled payment plan is a great option—the employer pays for the cost of a procedure that has been pre-determined, and in some cases, can leave its employee with little or no co-pay for a bundled payment plan procedure. Although the clinic with the best bundled plan may not be local, the savings in medical expenses can easily offset the cost of travel. As these plans rise in popularity and availability, companies have already begun to stop covering insurance and medical costs for employees who do not choose the bundled payment plans.
In the wake of the Affordable Care Act, many employers are finding ways to cut costs and provide affordable insurance plans for both employer and employee. Similar methods have begun in America’s hospitals and clinics, as facilities struggle to remain open with slow patient volume and a tough economy. Offering a discount can entice patients from out of town and out of state to clinics which are willing to provide care. These patients can help keep these facilities alive, financially speaking.
Although the bundled payment plan is an attractive option for cash-strapped patients with extensive medical needs, it may not be the best choice for doctors whom are being asked to participate. A shared sum means that the fees are divided out by the facility, and the doctor or hospital cannot charge more if necessary, even if the patient has an extended stay, or complications arise before, during, or after the surgery.
Healthcare attorneys in Florida, Georgia, New York and New Jersey say that bundled payment plans may be the way of the future, but other options are out there, if needed. Doctors and clinics across the country are working together to lower costs for surgery and implants in order to avoid bundled payments and still retain patient volume. These professionals hope to work with ACO insurance plans, fearing the repercussions of offering bundled payments, such as lower salaries and even compromised patient care.
At lawfirm Lubell Rosen, Sandra Greenblatt, based in the Coral Gables, Fla. office,and the firm’s other healthcare lawyers serve doctors and hospitals, offering legal counsel and representation for cases involving bundled payment plans and other ACO changes.