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Success in the Years Ahead

Donald Berwick, President Obama’s newly appointed CMS administrator, warns of “ill-considered autonomy” among health care professionals (Berwick, 2002). For example, as payment mechanisms are bundled (one payment shared by acute and post-acute programs and/or between hospitals and physicians and other professionals), clinicians will be chosen for the “bundle” who can produce results efficiently and who can perform collaboratively. Professionals who insist on “autonomy” and say that their services inherently “take longer” will likely not be chosen to participate. Instead of distancing ourselves from other health care professionals or seeking to increase a patient’s number of “visits” with little accountability for communicative outcomes, now is the time to engage in coordination of care with other clinicians to effect change in patients’ activities and participation. It is hoped that most SLPs will accept the increased scrutiny and challenges associated with health care reform and will work closely with others to achieve desired health care outcomes—our consensus goal.

Key Measures in Health Care Reform

Bundled Payments

Unlike traditional fee-for-service health care payment programs, bundled payments refer to “case rate,” “episode-based,” or “global” methods of compensation in which a single payment covers all services provided. The goals of CMs’ Acute Care Episode bundled payment demonstration program, for example, are to: improve price and quality transparency for informed decision-making; increase collaboration among providers and health systems; and reduce Medicare payments for acute-care services using market mechanisms. The global payment includes both hospital and physician services for select orthopedic and cardiac procedures for the episode of care. The participating sites are “value-based health care centers.”

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