CMS Unveils 4 Bundled Payment Models

Cheryl Clark, for HealthLeaders Media , February 4, 2013

But Barron and others acknowledge that the program is gambling that the hospitals won't lose money. "We're at risk for everything that happens 30 days post-discharge on the part A side" if it exceeds the established baseline, he says.

Barron is certain that his hospitals should go forward now and learn what they can, and not "just wait and try to bilk the last dollars out of the system as long as we can."

Rather, he says, those networks who figure out how to improve care and be more efficient, "who know how to manage populations and improve quality will deliver a value proposition, and they will be successful, and will be where the business is going. The future is not that far ahead. We think that by 2017, the whole system will be largely reformed."

4 Bundled Payment Models

1. Retrospective Acute Care Hospital Stay Only
Medicare pays the hospital a discounted amount based on the traditional Inpatient Prospective Payment System DRG rate, and pays physicians under their traditional fee schedules. But hospitals and physicians are permitted to share gains arising from the providers' care redesign efficiencies. 

The hospital, however, is responsible for some financial risk if Medicare Part A and Part B expenditures increase beyond a risk threshold for the period of the inpatient stay or during the 30 days after discharge, compared to historical expenditures.

2. Retrospective Acute Care Hospital Stay plus Post-Acute Care
The episode includes the acute care inpatient stay and all related services during the episode. The episode will end either 30, 60, or 90 days after hospital discharge. Participants can participate in any of up to 48 clinical condition episodes, from amputation to treatment of major vascular disorders. 


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2 comments on "CMS Unveils 4 Bundled Payment Models"

Peter Reisman (3/21/2013 at 7:40 PM)
It sounds simple, but these models will require substantial IT, medical records, accounting and management coordination support on the provider side, and claims processing, medical review, policy review and fraud control oversight on the government side. I have my doubts about the government's ability to manage them adequately.

Beryel Cox (2/5/2013 at 9:23 AM)
What needs to be done is the hiring of Health Information Management major at the partner level. Move beyond the old paradigm that the HIM graduate is well trained in Medical Record. The modern HIM Associate and Bachelor degree programs around this country and Canada are teaching us Health care systems. There is becoming a large pool of well trained HIM graduates that need the opportunity to do their PPE and find that first foot in the door. What other training program has as many classes in CMS payment models than the AHIMA approved programs. We are trained in understanding health care economics from the very first class, until we graduate. We understand the complex systems of modern health care. The HIM graduates are the rescue preservers for the sinking healthcare revenue ship. Understand what we study, understand how grueling the course of study is for a HIM major and then contact your local Community College and four-year college an hire from a AHIMA approved program. We all need employment!




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