The Benefits of Bundled Payment

Re: "Is Bundled Payment a Gift or Pandora's Box?" by Joseph Burns, April 2013 H&HN cover story

Structuring a bundled payment product takes a lot of work, so it may not look like a gift at first glance. It also forces administrators and physicians to reach consensus on what constitutes value to the organization, payers and patients. That's an outcome that many have claimed to want, but few have been able to deliver. That's the gift part. And there's one more gift to the industry and the economy that isn't mentioned.

Bundled payment forces providers to get specific about the quality, cost and coverage they provide. In doing so, it lays the groundwork for transparency and a real, market-based approach to health care.

As we have said in our recent book, Healthcare at a Turning Point, market discipline is the key to forcing health care institutions to become more responsive to patients, to improve quality and to eliminate errors, waste, and unnecessary treatment. Bundled payment will only be a Pandora's box for those providers who can't be competitive — and if we're going to have better quality at lower cost, those providers need to exit from the system.

— Michael Abrams
Managing partner
Numerof & Associates Inc.

Diabetes: A Need to Know More

Re: "Diabetes: An Alarming Epidemic" by Geri Aston, February 2013 H&HN

Great article! My daughter was diagnosed with T1D on 12/4/11 at age 12. After a four-day stay to get her sugar levels controlled and us "prepped" to begin a new life, we left the hospital. This was the start of transitioning to a new way of life for her and our family.

Even today, there are times we don't know what we don't know, questions that we should have asked and websites and/or conversations that we wish we would have had. I know firsthand that many others around the country feel the same way as they experience their child's condition for the first time. I challenge hospitals to step up and create these innovative programs to keep us engaged and educated on preventing and managing diabetes.

— Name withheld upon request

Less Than Excellent?

Re: "Hospital Centers of Excellence" by Marcy T. Rogers in H&HN Daily, April 11

If "80 percent of patients coming through the door do not require spine surgery but ultimately feed the entire hospital," something is wrong in marketing and developing a sustainable center of excellence in a given specialty. If referred patients are not screened better before the trip and largely end up in a remote hospital for alternative care, pretty soon "center of excellence" referrals will stop.

— Ron Hammerle

Good Insights on Rural Hospitals

Re: "Risk & Reward: Challenges Facing Rural Hospitals" by A. Clinton MacKinney, M.D., in H&HN Daily, April 17

As always, Dr. MacKinney is insightful, articulate and mission-focused in his comments. He nailed it both in terms of the current challenges as well as the things we need to be thinking about in rural health care to meet the changing needs of our patients and the way we are going to be paid in the future. Great answer regarding Matthew Weinstock's question about independence.

— Todd Linden
Grinnell (Iowa) Regional Medical Center

Talking About Costs

Re: "Desperately Seeking Innovation" by Paul Barr in H&HN Daily, April 10

Did [Mayo CEO John Noseworthy, M.D.] really say "skyrocketing" costs? If so, he may want to gather some further knowledge. Look no further than the rise in the average cost of care per Medicare recipient over the past three years. It has been well-documented.

— Jim Turnbull

Just Do It

Re: "Desperately Seeking Innovation"

The answer is a single-payer system. End of discussion.

— Bill Foucher