Evaluating CMS’ Bundled Payment Initiative

October 31, 2017

Telligen program evaluators, Dr. Christine LaRocca and Lindsay (Kirsch) Kaatz, are included in the list of authors for a recently released CMS annual report evaluating the Bundled Payments for Care Improvement (BPCI) initiative.

What is the BPCI?

The BPCI Initiative rewards participants financially for reducing Medicare payments for a clinical episode of care relative to a target price. The BPCI initiative tests four Models for linking provider payments for a clinical episode of care to determine whether bundled payments can reduce Medicare payments while maintaining or improving quality of care.

Who participates in BCPI?

BPCI Awardees, consisting of health care providers or other health care organizations, voluntarily enter into agreements with CMS to be held accountable for total Medicare episode payments. Awardees specify their model choice, as well as choose among several key options including payment approach, type of clinical episode, and episode definitions. This design implicitly recognizes the variability across health care markets, providers, and episodes of care.

What’s evaluated in the report?

The report provides insights into responses to bundled payment incentives, specifically BCPI Models 2, 3, and 4 covering the period of October 1, 2013 – September 30, 2015.

  • Model 2 – Includes the inpatient hospital stay and all concurrent professional services and other Medicare Part A and Part B-covered services within the chosen episode length of 30, 60, or 90 days post-discharge.
  • Model 3 – Starts when a beneficiary is admitted to a participating skilled nursing facility, home health agency, inpatient rehabilitation facility, or long-term care hospital within 30 days following a hospital discharge; and includes all Part A- and Part B covered services within the chosen episode length of 30, 60, or 90 days.
  • Model 4 – Starts when the beneficiary is admitted to the participating hospital for the chosen clinical episode; includes the anchor hospitalization, all professional services furnished during the anchor hospitalization, and any re-admissions and associated professional services that occur within 30 days of hospital discharge.

How will the results be used?

The resulting diversity in responses and impacts will provide the Centers for Medicare & Medicaid Innovation Center (CMMI) with information on the approaches that show the most promise in achieving payment reductions while maintaining or improving quality.

Where can I find a copy of the report?

The CMS report is available for download here.

 

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