• Hosp Case Manag. 2015 Sep 1;23(9):109-12.

AbstractThe 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.

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