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Innovations : bundled-payments-transplant

Supportive Financing Mechanisms

Bundled Payments For Transplant and Cardiovascular Services

 

Organization:  Johns Hopkins Medicine

Innovation Type: Bundled Payments for an Episode of Care

What They’re Doing:

Blood and Marrow Transplants: When clinically indicated and financially approved, JHM has been providing blood and marrow transplants on an outpatient basis. This improves patient satisfaction as the patient/family stay in a local hotel rather than the hospital. The patient is treated daily at the Kimmel Comprehensive Cancer Center . The majority of these patients will have some inpatient stay during their transplant during times when their immune system is insufficient to fight infection. Overall, health care costs are reduced because there are fewer inpatient days. With select payors, home care, housing and outpatient pharmacy costs are included in the bundled rate. Internal providers contact the Office of Managed Care rather than the payor for benefit coverage and authorizations. The usual co-pays and deductibles are eliminated or reduced because the transplant is being paid under a bundled rate. Administrative burden is reduced by having to call for fewer authorizations, having one office to call for authorizations and benefits and having to collect fewer co-pays.

Solid Organ Transplants: An outpatient infusion room was created to treat patients with antibiotics and anti-rejection medications on a daily outpatient basis, as needed. This room is open 7 days a week, 365 days a year. Prior to the creation of the infusion room, these patients were admitted to an inpatient bed for IV medications. A discharge planning position was created solely for solid organ transplant patients. The focus of this position is to ensure that the patient/family has the proper training and education to manage their health care needs at home once they are discharged.

Please note that not all types of Blood and Marrow and Solid Organ Transplants are billed under a bundled rate methodology.

Supportive Financing Mechanism: Johns Hopkins Medicine offers domestic payors bundled rates for blood/bone marrow and solid organ transplants. Bundled rates are also offered to international payors for cardiovascular procedures. These bundled payments cover all inpatient, outpatient, physician and hospital charges within a specified time period. The details of each contract varies: however, all bundled payment rates have a defined beginning and ending date, a list of included and excluded services and a per diem rate for inpatient days beyond a contractually specified number of days.

Evaluation type: Non-Experimental/ Qualitative Support

Evaluation plan: A registered nurse monitors clinical and financial performance of patients billed under a bundled rate on a concurrent basis. The financial performance of each contract and each procedure type is monitored on a monthly basis. There is ongoing communication/evaluation with the clinical teams to identify potential areas to modify care and identify changes in clinical protocols. Changes in any of these areas may lead to adjustments to the bundled rates, i.e. the rate itself, inclusions, exclusions, length of time. The financial performance of each contract is reviewed annually consistent with annual review date of the Alternative Rate Methodology as required by the Health Services Cost Review Commission (“HSCRC”). The HSCRC also requires the submission of Finance Reports (“A/R3”) on a quarterly and annually basis. The Office of Managed Care re-calculates the bundled rates and evaluates the entire program on an annual basis. A portion of the program evaluation includes the reconciliation of the payout of a gainshare if there is surplus, and physician withhold if specific performance targets are met.

Outcomes: The volume and revenue of the bundled rate program continues to grow every year. This is due to competitive pricing, quality care, and administrative ease. The bundled payment system is 90% automated.  The Office of Managed Care staff exhibit high service standards and are incredibly knowledgeable resulting in high levels of satisfaction for both payors and patients.

Publications: None

Target Population: Patients within the Johns Hopkins Medical System who are in need of the specific clinical services who are insured by a specific payor that chooses to enter a bundled payment arrangement with Johns Hopkins Medicine.

Date of Implementation: 1995

Contact: Trisha Frick, Assistant Director of Managed Care

Contracting, tfrick@jhmi.edu , (410) 424-4815

Where to learn more: Please contact Trisha Frick.

 
 
 

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