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Pricing the Bundle: Regression Methodology Dobson DaVanzo performed a series of multivariate regression analyses to simulate a nationwide bundled payment system • Dependent Variable: Current Medicare allowed payment per episode (including patient copayments, Indirect Medical Education [IME], disproportionate share hospital [DSH] payments, and capital) • Independent Variables: Beneficiary, facility, and episode characteristics (e.g. age, sex, chronic conditions, functional ability, IME, first post-acute care setting after hospital discharge) Simulated bundled payments are the “predicted” Medicare allowed payments under the various models for each patient episode Dobson/DaVanzo then applied an outlier model comparable to the Inpatient Prospective Payment System (IPPS) outlier policy 2012 AAMC Annual Meeting
Pricing the Bundle: Patient and Hospital Variables Included in Pricing Model Naïve Model Model A Model B Model C MS-DRGs x x x x Age Variable x x x Sex s x x x Race Include x x x Chronic d in Conditions x x x HCC Each Count x x x Functional Episode Ability x x x Live Paymen Alone x x x Dual t Model Eligibility x x x IME x x x DSH x x x Index Outlier Payment x x x Look Back CCU x x Look Back ICU x x Episode Death x x Region x x Rural x x Bed Size x x Unique Physician Count x x First PAC Setting x 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 and 60: Defining the Bundle Characteristics
Page 61 and 62: Pricing the Bundle Add-on payments
Page 63: Pricing the Bundle: Add-on Payments
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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