Value-based care and bundled payments have become more popular in ASCs as a way to lower the cost of services.
These value-based arrangements are typically implemented through a risk-based contract, often bundled or capitated payment models, according to a Nov. 3 report from JD Supra.
Here are five definitions to know for the agreements to be Stark and anti-kickback law compliant:
1. Value-based arrangement: an arrangement for value-based activity for a target patient population between the value-based enterprise and either one or more if its participants or the value-based enterprise participants in the same value-based enterprise.
2. Value-based enterprise: two or more value-based enterprise participants collaborating to achieve at least one value-based purpose. There must also be an accountable body or person responsible for financial and operational oversight and a governing document describing the enterprise.
3. Value-based participant: an individual or entity that engages in value-based activity as part of a value-based enterprise.
4. Value-based purpose: a purpose involving either coordinating and managing care of a patient population, improving quality of care for the target patient population, reducing cost to payers without reducing quality of care, or transitioning from fee-for-service healthcare to quality of service healthcare.
5. Value-based activity: any of the following activities provided that it is reasonably designed to achieve a value-based purpose: the provision of an item or service, the taking of an action or the refraining of taking an action.
Read more about the definitions here.