Providers named for CMS bundled payment initiative

AHA News
 More than 500 organizations will participate in the Bundled Payments for Care Improvement initiative, the Centers for Medicare & Medicaid Services (CMS) announced last week.

The Medicare demonstration, announced in August 2011, will bundle payment for an episode of inpatient and/or post-acute care in an effort to better coordinate care for patients and reduce costs.

The initiative, authorized under the “Patient Protection and Affordable Care Act,” includes four models of bundling payments, varying by the types of health care providers involved and the services included in the bundle. The agency’s Jan. 31 announcement includes 32 organizations that will begin testing bundled payments for acute care hospital stays as early as April 2013 under Model 1 of the program.

The announcement also includes participants for Phase 1 of Models 2, 3, and 4, which will run through July 2013.

Phase 1 organizations will receive new data from CMS on care patterns and engage in shared learning in how to improve care.

They generally are expected to participate in Phase 2, in which approved participants opt to take on financial risk for episodes of care starting in July 2013. More Model 1 participants. In coming weeks, CMS plans to announce a second opportunity for providers to participate in Model 1, with an anticipated start date of early 2014.

“The objective of this initiative is to improve the quality of health care delivery for Medicare beneficiaries, while reducing program expenditures, by aligning the financial incentives of all providers,” CMS Acting Administrator Marilyn Tavenner said in a statement.

Depending on the model type, CMS will bundle payments for services beneficiaries receive during an episode of care, encouraging hospitals, physicians, postacute facilities, and other providers as applicable to work together to improve health outcomes and lower costs.

Under Model 1, Retrospective Acute Care Hospital Stay Only, CMS will pay a discounted amount based on payment rates set in the traditional Medicare payment schedule.

Physicians will continue to be paid separately for their services under the regular Medicare physician fee schedule. Under certain circumstances, hospitals and physicians will be permitted to share any savings resulting from their efforts to better coordinate care.

The other three models included in the initiative are:

• Retrospective Acute Care Hospital Stay Plus Post-Acute Care (Model 2): The model will include the inpatient hospital stay and will end either 30, 60, or 90 days after hospital discharge; • Retrospective Post-Acute Care Only (Model 3): The episode of care included in the model will be triggered by an acute care hospital stay and will begin at initiation of post-acute care services with a participating skilled nursing facility, inpatient rehabilitation facility, long-term care hospital, or home health agency; and

• Acute Care Hospital Stay Only (Model 4): CMS will make a single, prospectively determined bundled payment to the hospital that would cover all services furnished during the inpatient stay.

Physicians will be paid by the hospital as part of the bundled payment.

For more on the announcement, click on:
Topic: Advocacy and Public Policy

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