Last week we covered the CMS announcement about the many provider organizations that had signed up for the Medicare bundled payment initiative, 200+ Health & Long-Term Care Provider Organizations Sign Up For Medicare Bundled Payment Initiative premium members. The initiative is expansive – including hospitals, physician practices, skilled nursing facilities, nursing homes, home health organizations, and post-acute care provider organizations.
If you thought perhaps you should participate after reading the article, it’s not too late. I was surprised to see an announcement from the federal Centers for Medicare and Medicaid Services (CMS) calling for more provider organizations to participate. Interested organizations have until April 18, 2014 to apply.
If this piques your interest, there are four models in the program – and CMS is continuing to accept applications for three of them.
|Bundled Payments For Care Improvement Models|
|BPCI Model||Model Title||Bundle Coverage||Clinical Episodes|
|2||Retrospective acute and post-acute care episode||Inpatient services, physicians’ services, care by the post-acute provider, and related readmissions within 30 days||One or more of 48 clinical conditions targeted by CMS|
|3||Retrospective post-acute care only||Post-acute care services provided within 30 days of discharge from the inpatient stay; ending either 30, 60, or 90 days after initiation of the episode||One or more of 48 clinical conditions targeted by CMS|
|4||Prospective acute care hospital stay only||Inpatient services, physician services, and related readmissions within 30 days||One or more of 48 clinical conditions targeted by CMS|
Model 2: Retrospective Acute Care Hospital Stay plus Post-Acute Care – In this model, the episode of care includes the inpatient stay in the acute care hospital and all related services during the episode. The episode will end either 30, 60, or 90 days after hospital discharge.
Model 3: Retrospective Post-Acute Care Only – In this model, the episode of care will be triggered by an acute care hospital stay and begins at initiation of post-acute care services with a participating skilled nursing facility, inpatient rehabilitation facility, long-term care hospital or home health agency. The post-acute care services included in the episode must begin within 30 days of discharge from the inpatient stay and will end either 30, 60, or 90 days after the initiation of the episode.
Model 4: Prospective Acute Care Hospital Stay Only – In this model, CMS makes a single, prospectively determined bundled payment to the hospital that encompasses all services furnished during the inpatient stay by the hospital, physicians, and other practitioners. Physicians and other practitioners will be paid by the hospital out of the bundled payment. All services furnished during related readmissions for 30 days after hospital discharge are also included in the bundled payment amount.
The goal of each of these models is simple: to improve patient care and lower Medicare costs. But making that happen is easier said than done. And while none of the episodes of care explored in these models are directly related to behavioral health conditions, I predict that we’ll continue to see payers experimenting with more more bundled payment rates, and similar types of competitive risk-based financing models.
Over the next few years, we’ll begin to see how successful these bundled payment models are, and from there, CMS and other payers will determine how to expand these models throughout the health care system – stay tuned for the results!