Hospitals

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Bundled Payment Models Overview Episode Definition Beneficiary Inclusion Criteria (Reason for hospitalization + other) Trigger MS- DRGs Inpatient Index Hospitalization Professional Index Inpatient Hospitalization Professional Professional Services Facility & Other Services Outpatient Professional Post-Acute: IRF, SNF, HHA Episode anchor End of Episode Episode Payment CMS characterizes this as a “discount arrangement” NOT “shared savings” so that awardees can participate in other CMS “shared savings” initiatives Prior Amount Traditional Medicare FFS $ New: Episode Target Price Discounted Traditional Medicare FFS $ (Retrospective Reconciliation) Model #2,#3 Prospective Medicare Payment Amount $ Model #4 74 2012 AAMC Annual Meeting
AAMC Applicant Organizations • Albert Einstein Healthcare Network (PA) • Atlantic Health (NJ) • Duke • NYU Langone Medical Center • Our Lady of the Lake Regional Medical Center (LA) • Penn State Hershey Health System • Sinai Health System (IL) • UCSF • University of Colorado • Vanderbilt University Medical 75 2012 AAMC Annual Meeting
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State of the Academic Clinical Ente
Page 3 and 4:
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
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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 and 70: Managing the Bundle: Percent of Rea
Page 71 and 72: Key Findings • Bundling is here
Page 73: Bundled Payments for Care Improveme
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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