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Managing the Bundle: Understanding the Patterns MS-DRG 470:Major joint replacement or reattachment of lower extremity w/o MCC Facility-Based Sequence Stops: A=STACH (Index or Readmission) H=HHA I=IRF L=LTCH S=SNF Ambulatory-Based Sequence Stops: C=Community (Physician and Outpatient) E=ER P=OP Therapy T=Hospice Z=Other IP Pathway Number of Episodes Percent of Episodes Average Medicare Episode Paid A-H-C 236,300 20.7% $14,519 A-S-H-C 116,300 10.2% $20,039 A-S 88,900 7.8% $23,396 A-C 84,220 7.4% $12,078 A-I-H-C 50,460 4.4% $26,925 A-S-C 48,620 4.3% $18,786 A-S-H 44,240 3.9% $21,481 A-H-C-P 34,360 3.0% $14,649 A-H 26,860 2.4% $14,145 A-P-P 24,740 2.2% $12,317 Subtotal 755,000 66.2% $17,575 Other 385,340 33.8% $21,501 Total 1,140,340 100.0% $18,901 Source: Dobson | DaVanzo analysis of research-identifiable 5% SAF for all sites of service, 2007-2009, wage index adjusted by setting and geographic region, and standardized to 2009 dollars. All episodes have been extrapolated to reflect the universe of Medicare beneficiaries. Medicare Episode Paid includes care from all facility-based and ambulatory care settings and excludes beneficiary co-payments. IME, DSH, copay, capital, and other third party have been removed from payments. HH PPS payments do not include payments for Part D drug or DME services that are provided under SNF, IRF, and LTCH PPS payments. 70 2012 AAMC Annual Meeting
Key Findings • Bundling is here • Providers/policy makers need to consider several factors in designing/implementing bundling program • Pricing the bundle • Including beneficiary demographic and clinical characteristics, as well as add-on payment factors in risk adjustment better predict price of a bundle • Managing the Bundle • Understand how patient moves through bundle • Readmission trends Issue Brief and Comprehensive Report at www.aamc.org/bundling 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
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COTH Quarterly Survey Results 2009-
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Medicare Resident Limits: Mandated
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Resident Limit Redistributions ACA
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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 and 66: Pricing the Bundle: Patient and Hos
Page 67 and 68: Managing the Bundle: Readmissions s
Page 69: Managing the Bundle: Percent of Rea
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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