Hospitals
Hospitals
Hospitals
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Bundled Payment Models<br />
Overview<br />
Episode<br />
Definition<br />
Beneficiary<br />
Inclusion<br />
Criteria<br />
(Reason for<br />
hospitalization<br />
+ other)<br />
Trigger<br />
MS-<br />
DRGs<br />
Inpatient Index Hospitalization Professional<br />
Index Inpatient Hospitalization<br />
Professional<br />
Professional Services<br />
Facility & Other Services<br />
Outpatient Professional<br />
Post-Acute: IRF, SNF, HHA<br />
Episode anchor<br />
End of Episode<br />
Episode Payment<br />
CMS characterizes this as a<br />
“discount arrangement”<br />
NOT “shared savings” so<br />
that awardees can<br />
participate in other CMS<br />
“shared savings” initiatives<br />
Prior Amount<br />
Traditional<br />
Medicare FFS $<br />
New: Episode Target Price<br />
Discounted<br />
Traditional<br />
Medicare FFS $<br />
(Retrospective<br />
Reconciliation)<br />
Model #2,#3<br />
Prospective<br />
Medicare<br />
Payment<br />
Amount $<br />
Model #4<br />
74<br />
2012 AAMC Annual Meeting
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