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Cardiac and Orthopedic MS-DRGs, Stroke, and Heart Failure Meet Several Characteristics Important for Payment Bundling Prevalent High Low Evidence- Select MS-DRG Families by Criteria for in High Total Average Variance in Based Payment Bundling* Medicare Episode Episode Episode Practice MS-DRG Family Population Payments Payment Payments Guidelines Acute ischemic stroke w use of thrombolytic agent (61, 62, 63) x x Intracranial hemorrhage or cerebral infarction (64, 65, 66) x x x Nonspecific cva & precerebral occlusion w/o infarct (67,68) x Chronic obstructive pulmonary disease (190, 191, 192) x x x Simple pneumonia & pleurisy (193, 194, 195) x x x Cardiac valve & oth maj cardiothoracic proc (216, 217, 218, 219, 220, 221) x x x Coronary bypass (231, 232, 233, 234, 235, 236) x x x Perc cardiovasc proc w drug-eluting stent (247) x x x x Heart failure & shock (291, 292, 293) x x x Bilateral or multiple major joint procedures of lower extremity (461, 462) x x x Revision of hip or knee replacement (466, 467, 468) x x x Major joint replacement or reattachment of lower extremity (469, 470) x x x x Hip & femur procedures except major joint (480, 481, 482) x x x x x *Criteria include prevalence in the Medicare population (>1% of episodes), high total episode payments (>2% of total payments) or average episode payments (>$20,000), low variance in episode payments (CV
Pricing the Bundle Add-on payments such as indirect medical education (IME) and disproportionate share (DSH) affect the price of bundle • Including add-ons to the bundle increases the average bundle price for major teaching hospital • Yet excluding add-ons from bundle calculations does not recognize losses from reduced readmissions 2012 AAMC Annual Meeting
Page 1 and 2:
State of the Academic Clinical Ente
Page 3 and 4:
AAMC Health Care Affairs • Suppor
Page 5 and 6:
DataTrends: Hospital Margins 2012 A
Page 7 and 8:
Hospital Total All-Payer Margins, b
Page 9 and 10: COTH Characteristics Short-Term, Ge
Page 11 and 12: COTH Quarterly Survey Results 2009-
Page 13 and 14: Medicare Resident Limits: Mandated
Page 15 and 16: Resident Limit Redistributions ACA
Page 17 and 18: Sec. 5506 Slots by Teaching Status
Page 19 and 20: Sec. 5506 DGME Slots by State - Fir
Page 21 and 22: 2012 AAMC Annual Meeting Readmissio
Page 23 and 24: Concern with Risk Adjustment • Ri
Page 25 and 26: Readmission Rates are Higher for Du
Page 27 and 28: Approach: Model Specification and S
Page 29 and 30: Readmission Program Impact on COTH
Page 31 and 32: Value-Based Purchasing (VBP) • Mo
Page 33 and 34: How is the VBP Money Moving? Major,
Page 35 and 36: Medicare Spending Per Beneficiary (
Page 37 and 38: Exclusions •IME and DSH payments
Page 39 and 40: MSPB National Distribution 50% Medi
Page 41 and 42: MSPB - Where Spending Occurs Breakd
Page 43 and 44: Physician Payments at HOPD For many
Page 45 and 46: MedPAC Proposal 99213 - Midlevel Es
Page 47 and 48: Study AAMC contracted with The Mora
Page 49 and 50: Distribution of Medicare E/M Visits
Page 51 and 52: Major Teaching Hospitals Serve Prop
Page 53 and 54: High Level Findings • Proposed
Page 55 and 56: What is a bundled payment? • New
Page 57 and 58: AHA-AAMC Bundling Analysis Key Ques
Page 59: Defining the Bundle Characteristics
Page 63 and 64: Pricing the Bundle: Add-on Payments
Page 65 and 66: Pricing the Bundle: Patient and Hos
Page 67 and 68: Managing the Bundle: Readmissions s
Page 69 and 70: Managing the Bundle: Percent of Rea
Page 71 and 72: Key Findings • Bundling is here
Page 73 and 74: Bundled Payments for Care Improveme
Page 75 and 76: AAMC Applicant Organizations • Al
Page 77 and 78: Brandeis Data Analysis Total allowe
Page 79 and 80: BPCI Lessons Learned To Date • AM
Page 81: Questions??? Additional information
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Hospitals

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