PROMETHEUS is a pilot project in bundled payments on the part of three health care systems. According to a report in Health Affairs the project lies dormant after three years of trying to get it off the ground. The abstract of the Health Affairs article euphemistically concludes:
Participants continue to see promise and value in the bundled payment model, but the pilot results suggest that the desired benefits of this and other payment reforms may take time and considerable effort to materialize.
A closer look at the project, according to this Medscape report, reveals the true magnitude of the problems. The Medscape piece opens:
November 10, 2011 — A new study published in the November issue of Health Affairs throws cold water on the notion that healthcare reform can quickly replace the fee-for-service (FFS) system...
Hold it right there. Much of the medicine we practice today is non-fee for service. Almost all hospital reimbursement for inpatient services is bundled and has been since the implementation of the Prospective Payment system in 1984. So the experiment in bundling is not new. We've already learned some hard lessons from the Prospective Payment system. With the implementation of DRGs in 1984 hospitals had some tough choices. They could cut corners, play games with Medicare, shift costs or fold. Reports in the medical literature from the beginning of that era suggested that as a result of the new incentives patients tended to be discharged prematurely and may have suffered bad outcomes as a result.
It was a negative cost incentive program with workarounds and loopholes. What's new in health care reform is that the negative cost incentives will now be on steroids. The bundling will be much more inclusive and the workarounds more difficult.
Continuing from the first paragraph of the Medscape piece:
and all its attendant problems, with new models of reimbursement that reward the quality of care..
Quality of care. We know what that means in the administrative world. It means performance. Performance that has nothing to do with real quality and has never been demonstrated to benefit patients.
Go ahead and read the rest of the Medscape piece and get an idea of what a nightmare this project is and consider in particular this statement:
They also note that many healthcare organizations that might start a bundled-payment system would be less prepared than the PROMETHEUS participants, which are sophisticated integrated delivery systems. As a consequence, their struggles might even be more prolonged.
