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Pricing the Bundle: Factors that Drive Payment Bundles Progression of R 2 Value with Addition of Variables in Model A, Model B, and Model C All MS-DRGs (Number of Observations = 1,292,352) Regression Model Variables Cumulative R 2 * MS-DRG 0.511 Age, Sex, Race 0.514 Chronic Conditions 0.528 Model A HCC Count 0.534 Functional Ability and Live Alone 0.647 Model B = Contribution to Explained Variance Dual Eligibility 0.647 IME, DSH, Index Outlier Payment 0.669 Look Back CCU, ICU, and Episode Death 0.669 Region 0.669 Rural 0.669 Bed Size 0.670 Unique Physician Count 0.762 Model C First PAC 0.781 Source: Dobson | DaVanzo Analysis, 30-day episodes , 2007-2009 5% Medicare claims, no outlier model applied * The adjusted-R 2¸ which accounts for degrees of freedom, was nearly identical to the R 2 values presented and follows the same trend. 2012 AAMC Annual Meeting
Managing the Bundle: Readmissions significantly add to cost of episode Average Medicare Episode Paid by Readmission Status for Select MS-DRGs (30-Day Episode) Average Medicare Episode Paid $35,000 $30,000 $25,000 $20,000 $15,000 $10,000 $5,000 Surgical Medical $0 247 470 481 192 194 291 MS-DRG Episode With a Readmission Episode Without a Readmission 247: Percutaneous cardiovascular procedure with drug-eluting stent w/ MCC 192: Chronic obstructive pulmonary disease without CC/MCC 470: Major joint replacement or reattachment of lower extremity w/o MCC 194: Simple pneumonia & pleurisy w CC 481: Hip & femur procedures except major joint w CC 291: Heart failure & shock w MCC Source: Dobson | DaVanzo Analysis, 30-day episodes, 2007-2009 5% Medicare claims 67 2012 AAMC Annual Meeting
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State of the Academic Clinical Ente
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AAMC Health Care Affairs • Suppor
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DataTrends: Hospital Margins 2012 A
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Hospital Total All-Payer Margins, b
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COTH Characteristics Short-Term, Ge
Page 11 and 12:
COTH Quarterly Survey Results 2009-
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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 and 64: Pricing the Bundle: Add-on Payments
Page 65: Pricing the Bundle: Patient and Hos
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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