Acute and Post-Acute Care Bundled Payments and Care Coordination in Rural Environments
Project goals: The purpose of this project is to: 1) Identify opportunities and potential unintended consequences for rural providers of current proposals for implementing bundled payments for acute and post-acute care episodes; 2) Describe modifications to current bundling proposals that will address rural-specific issues; and 3) Identify quality measures related to care coordination that are relevant for rural patients whose services are reimbursed by a bundled payment.
Methods: We will review the literature on economics of organizations, rural health, and organization theory to identify opportunities and potential unintended consequences with bundling acute and post-acute care episode payments in rural settings. The results from this literature review will inform a set of structured interviews with administrators in rural PPS hospitals, CAHs, long-term care, rehabilitation facilities and home health agencies in rural settings and with referral hospitals and primary care and specialty physicians. Finally, we will review the literature on care coordination related issues particularly in the context of developing relevant quality-related measures. We will use the interview results and the care coordination literature review to develop a set of quality measures related to care coordination that are relevant to rural patients whose services would be reimbursed by a bundled payment. The quality measures will be reviewed by a set of experts with knowledge of care coordination issues as well as the rural health environment, and adapted as needed.
Anticipated Publications or Products: The products of this project will include a final report, a policy brief, an article that will be submitted to a peer-reviewed journal, and presentation abstracts that will be submitted to state, regional and national conferences.
Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients
Upper Midwest Rural Health Research Center
This report assesses the challenges and consequences for rural providers and patients of implementing bundled payments for acute and post-acute care episodes; explores impacts on care quality under a facility-physician bundled payment system; and describes potential modifications to bundling proposals and steps that could address rural issues.