Under the Bundled Payments for Care Improvement initiative, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare.
For Model 3, the episode of care 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. The post-acute care services included in the episode must begin within 30 days of discharge from the inpatient stay and will end either a minimum of 30, 60, or 90 days after the initiation of the episode. Participants can select up to 48 different clinical condition episodes.
Background
In both Models 2 and 3, the bundle will include physicians’ services, care by post-acute providers, related readmissions, and other related Medicare Part B services included in the episode definition such as clinical laboratory services; durable medical equipment, prosthetics, orthotics and supplies; and Part B drugs. A target price will be set that will be based on historical fee-for-service payments for the participant’s Medicare beneficiaries in the episode and will include a discount. Payments will be made at the usual fee-for-service payment rates, after which the aggregate Medicare payment for the episode will be reconciled against the target price. Any reduction in expenditures beyond the discount reflected in the target price will be paid to the participant and may be shared among their provider partners. Any expenditures that are above the target price will be repaid to Medicare by the participant.
Medicare currently makes separate payments to providers for the services they furnish to beneficiaries for a single illness or course of treatment, leading to fragmented care with minimal coordination across providers and health care settings. Payment is based on how much a provider does, not how well the provider does in treating the patient.
Research has shown that bundled payments can align incentives for providers – hospitals, post acute care providers, doctors, and other practitioners – to partner closely across all specialties and settings that a patient may encounter to improve the patient’s experience of care during a hospital stay in an acute care hospital, and during post-discharge recovery.
On January 31, 2013 Phase 1 participants were announced. Phase 1 (January-July 2013), also referred to as the “no risk preparation” period, is the initial period of the initiative, where CMS and participants prepare for implementation and assumption of financial risk. All candidates included in Phase 1 submitted a final list of their episodes and planned partners in December 2012.
The “risk-bearing implementation” period, Phase 2, is expected to begin in July 2013. Those participants in Phase 1 of Models 2, 3, and 4, that are ultimately approved by CMS and decide to move forward with implementation and assume financial risk, may enter into a Bundled Payments for Care Improvement Model agreement with CMS and begin Phase 2 of the Model.
Phase 2 is expected to begin in July 2013. The beginning of Phase 2 would mark the beginning of the performance period, or risk-bearing period.
Model 3 participants
- Brooks Health System (Jacksonville, FL) This participant is a convener of health care facilities in FL
- Good Shepherd Rehabilitation Hospital (Allentown, PA)
- Illinois Bone & Joint Institute, LLC (Des Plaines, IL)
- Golden Living (GGNSC Administrative Services, LLC) (Washington, DC) This participant is a convener of health care facilities in CA, WI, PA, VA
- Optum (Brentwood, TN) This participant is a convener of health care facilities in PA, NJ, IL, MI
- Kindred Healthcare (Louisville, KY) This participant is a convener of health care facilities in OH
- Chatsworth at Wellington Green, LLC (Wellington, FL) This participant is a convener of health care facilities in FL
- Remedy Partners, Inc (Darien, CT) This participant is a convener of health care facilities in MA, NY, NJ, PA, TX, CT, DE, AL, GA, NC, TN
- Amedisys Holdings (Baton Rouge, LA) This participant is a convener of health care facilities in LA, MS, WV, SC, KY, TN, IN
- At Home Network (Bingham Farms, MI) This participant is a convener of health care facilities in MI
- CareLink Inc. (Providence, RI) This participant is a convener of health care facilities in RI
- Health Care Navigator, LLC (White Plains, NY) This participant is a convener of health care facilities in FL, MS
- Mid-Atlantic Health Care (Timonium , MD) This participant is a convener of health care facilities in PA
- The Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD) This participant is a convener of health care facilities in SD, MN
Additional Information
