Marshall Medical Center chosen to join new gov’t billing plan

The Centers for Medicare & Medicaid Services (CMS) announced Jan. 31 that Marshall Medical Center will be one of seven hospitals in California that will begin participating in the Bundled Payments for Care Improvement initiative.

Through this new initiative, made possible by the Affordable Care Act, CMS will test how bundling payments for episodes of care can result in more coordinated care for beneficiaries and lower costs for Medicare.

“The objective of this initiative is to improve the quality of health care delivery for Medicare beneficiaries, while reducing program expenditures, by aligning the financial incentives of all providers,” said CMS Acting Administrator Marilyn Tavenner.

Through participation, Marshall will receive a fixed payment to care for Medicare patients from admission through 90 days after discharge from the hospital for episodes including stroke, congestive heart failure, pneumonia and total joint replacement. All costs the patient incurs will be deducted from a flat fee. This includes hospital, physician, home health and skilled nursing services. “Our challenge will be to provide improved care in a more efficient manner, resulting in better recovery and outcomes,” said James Whipple, CEO, Marshall Medical Center.

For more than a year, and in anticipation of being selected, Marshall has been preparing for participation in the three-year innovation project.

“As an organization, we are already doing better than other hospitals when it comes to outcomes and costs for certain disease states. We’re coming from a good place. Through conversations with our staff and physicians, the consensus was that if we really focused our coordination of care, we could do even better,” said Whipple.

Selection for the program included four rounds of analysis from a nationwide pool, including quality data, capabilities and commitment to the program.

The Bundled Payments for Care Improvement initiative includes four models of bundling payments, varying by the types of health care providers involved and the services included in the bundle.  Depending on the model type, CMS will bundle payments for services beneficiaries receive during an episode of care, encouraging hospitals, physicians, post-acute facilities, and other providers as applicable to work together to improve health outcomes and lower costs.

Organizations of providers participating in the initiative will agree to provide CMS a discount from expected payments for the episode of care, and then the provider partners will work together to reduce readmissions, duplicative care, and complications to lower costs through improvement.

El Dorado County has the highest population of senior citizens in California and Medicare patients account for approximately 55 percent of Marshall’s patient base.

“Learning how to better serve this age group is part of our mission. Learning how to provide high-quality care under the new guidelines will benefit not only our community hospital, but our patients. If we are successful in lowering the cost of providing care, patients will also see lower deductibles and co-pays,” said Whipple.

The announcement marks the start of Phase 1 of Models 2, 3, and 4. In Phase 1 (January-July 2013), over 100 participants partnering with over 400 provider organizations, will receive new data from CMS on care patterns and engage in shared learning in how to improve care. Phase 1 participants are generally expected to become participants in Phase 2, in which approved participants opt to take on financial risk for episodes of care starting in July 2013, pending contract finalization and completion of CMS’ standard program integrity reviews.

Marshall Medical Center is an independent, nonprofit community healthcare provider located in the heart of the Sierra Foothills. Marshall Medical Center includes Marshall Hospital, a fully accredited acute care facility with 113 beds in Placerville; several outpatient facilities in Cameron Park, El Dorado Hills and Georgetown; and many community health and education programs. Marshall has more than 200 board-certified physicians and 1,300 employees providing quality healthcare services to more than 175,000 residents of El Dorado County.