Hosp Case Manag. 2015 Sep;23(9):109-12.
The Centers for Medicare & Medicaid Services' (CMS') mandatory bundled payment pilot project makes clear that the agency intends to reform Medicare reimbursement. Hospitals in 75 geographic areas are required to participate in a five-year pilot project that puts them at risk for the cost of hip and knee replacements from the time of surgery until 90 days after discharge. Already, more than 6,500 providers are participating in the Bundled Payments for Care Improvement project, a voluntary program where participants can choose from 48 clinical episodes and four models. Even if they won't be part of a bundled payments arrangement, case managers need to shift their thinking to prepare for the future of reimbursement by developing close working relationships with post-acute providers, knowing the services and quality delivered by post-acute providers, and being aware of the costs for the entire episode of care. Case managers will not be able to handle all the responsibilities necessary in a bundled payment arrangement if they have large caseloads.
医疗保险和医疗补助服务中心（CMS）的强制性捆绑支付试点项目明确表明，该机构有意改革医疗保险报销方式。75个地理区域的医院被要求参与一项为期五年的试点项目，该项目使医院在从手术之时到出院后90天这段时间内，承担髋关节和膝关节置换手术费用的风险。目前，已有超过6500家医疗机构参与了“改善护理捆绑支付”项目，这是一个自愿参与的项目，参与者可以从48种临床诊疗过程和4种模式中进行选择。即使不会参与捆绑支付安排，个案管理员也需要转变思维，通过与急性后期医疗机构建立密切的工作关系、了解急性后期医疗机构提供的服务和质量，以及知晓整个护理过程的费用，为未来的报销方式做好准备。如果个案管理员的工作量很大，他们将无法承担捆绑支付安排中所需的所有职责。
