Albany partner Matthew Amodeo was quoted in Modern Healthcare discussing the new bundled payment initiative announced last week by the U.S. Department of Health and Human Services (HHS) through the Center for Medicare and Medicaid Innovation.

Matt, partner in the Health Law Practice Group, drew a parallel between this initiative and the center's Pioneer ACO model, which offered more flexibility than the proposed ACO rule outlined this spring. In the same way, the Innovation Center is providing more breathing room for healthcare providers who understand that a more-coordinated healthcare system is here to stay.

HSS statistics indicate that the bundled payment initiative builds on previous successful research and demonstration projects, including a five-year heart bypass center demonstration in 1986 that saved the Medicare program about $42.5 million.

Health care providers, however, still have concerns regarding the model. While bundled payments could create incentives for discouraging unneeded services, research has suggested they do not discourage unnecessary episodes and providers may run into difficulties if payers aren't on board with new payments models, such as bundled payments and ACOs.

“Some of my clients are experiencing reluctance from commercial payers to enter into these cross-provider arrangements for fear that these provider arrangements will be so big that they will exert leverage over payers,” said Matt.

Medicare experiments such as bundled payments and incentives for patient-centered medical homes, he added, are “what the midlevel and smaller systems are looking to do as a first step before jumping whole hog into an ACO-type arrangement.”
Source: Modern Healthcare