In 2014, Lancaster General Hospital (LGH) began participating in a Medicare initiative called Bundled Payments for Care Improvement (“BPCI”). This participation means LGH voluntarily agreed to partner with physicians on a new payment initiative with the goal of providing high-quality, efficient, and more-coordinated care.

This initiative only is relevant for Medicare patients undergoing one of the following procedures as part of a hospital stay:

  • Coronary Artery Bypass Grafting (CABG surgery)
  • Coronary Artery Angioplasty and/or Stenting
  • Pacemaker Implantation
  • Defibrillator Implantation
  • Knee Replacement
  • Hip Replacement
  • Spinal Surgery

Bundled Payments Help Deliver Better Care

Medicare is using the BPCI initiative to provide doctors and hospitals with increased opportunities to take the quality and efficiency of care to the highest level possible. By working more closely together on planning and delivering care, we anticipate that we can remove inefficiency and waste from our care delivery processes and in doing so lower the costs of care to Medicare.

The focus of this initiative is to increase quality and coordination of care. Hospitals, doctors, and other healthcare providers that deliver care during and after a hospital stay may be rewarded for providing high-quality, more-coordinated care. Medicare will monitor our care and the hospital and physicians’ performance to assure that quality is being increased.

Medicare will make a single payment to LGH for all hospital and doctor services during a patient’s hospital stay and for any re-hospitalizations related to the patient’s condition that happen within 30 days after that hospital stay. Patients are still responsible for the coinsurance amounts and any applicable deductible for the hospital and doctors’ services.

Patients Choose Their Hospital or Doctor

Patients continue to have the right to choose which hospital or doctor will deliver their care. If their BPCI-associated procedure has yet to be performed and they wish to not participate in this initiative, patients would need to transfer to a non-participating facility. Patients should discuss this with your doctor first, before considering a transfer.

Bundled Payments Explained

The video below provides additional information to help explain bundled payments.

 

Frequently Asked Questions

Find answers to some of our most frequently asked questions:

What is the Bundled Payments for Care Improvement (BPCI) initiative?

Lancaster General Hospital (LGH) is participating in a Medicare initiative called Bundled Payments for Care Improvement initiative. Medicare is using the BPCI initiative to encourage doctors and hospitals to work more closely together to improve patient care. Patients benefit because LGH and its medical staff will have an additional incentive to provide high-quality care with greater efficiency and lower cost. Medicare will monitor the care we provide to make sure patients get high-quality care.

How does Bundled Payments for Care Improvement work?

Medicare will make a single payment to LGH for all hospital and doctor services during the patient’s hospital stay and for any re-hospitalizations within 30 days related to the patient’s condition.

How does Bundled Payments for Care Improvement improve care?

BPCI places a greater emphasis on providing the highest quality, cost-effective care. Under traditional fee-for-service payments, hospitals and doctors are rewarded for performing procedures with little or no incentive to coordinate care. When hospitals and doctors share a fixed, lump-sum payment, it encourages collaboration to improve the quality and efficiency of care provided to patients.

Does Bundled Payments for Care Improvement affect my Medicare insurance coverage?

Your Medicare benefits are unchanged and not affected by BPCI. You will still have to pay the coinsurance amounts and any applicable deductible for hospital and doctor services. These will be identified in the Medicare Summary Notice you will receive from Medicare, just as they are now.

Will I be cared for differently under the Bundled Payments for Care Improvement initiative?

Our first goal and responsibility is to provide you with high-quality, safe, and effective healthcare. The BPCI Initiative does not change that, nor does it change any of your benefits under Medicare. You retain the right to use any doctor or hospital you choose. What BPCI will do is help LGH and its doctors develop innovative ways to provide high-quality care more efficiently and at lower cost. LGH and its doctors will still be monitored closely to ensure the quality of our care.

What services are included in the "episode of care?"

Included in the episode of care are services associated with the initial hospitalization provided by surgeons, anesthesiologists, radiologists, consulting physicians and all advanced practice providers; all post-op care, including room and board; all medical and surgical supplies; medications, lab, and X-ray; ancillary services and routine charges and any services associated with a readmission within 30 days of the initial hospitalization.

What if I do not want my care provided under the Bundled Payments for Care Improvement initiative?

You have the right to choose which hospital or doctor will deliver your care. If your BPCI- associated procedure has yet to be performed and you wish to not participate in this initiative, you would need to transfer to a non-participating facility. Please discuss this with your doctor first, before considering a transfer.

Find a different hospital by visiting Medicare’s Hospital Compare or find a different doctor with Medicare’s Physician Compare. You can also access these options by calling 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048.

For More Information

If you have concerns, complaints or questions about Bundled Payments for Care Improvement, ask your physician, call Lancaster General Hospital at (888) LGH-INFO or call (800) MEDICARE. More Medicare information is available at Centers for Medicare & Medicaid Services.

Discover more helpful information by reading some of our most frequently asked questions about Bundled Payments for Care Improvement.

 

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