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Anticipated CMS Timeline Early October Mid- October Winter 2012/2013 Late Spring 2013 76 • After review • CMS to release panels complete information on recommendations, determining target CMS will notify price, risk applicants of adjustment, status (“candidate beneficiary awardee” or not) exclusions, • CMS staff will pro-ration initiate methodology for conversations with candidates “candidate • CMS works to awardees” address • CMS to present “candidate range of awardee” “converged questions episode definitions” • Waiver discussion 2012 AAMC Annual Meeting • CMS will identify “recommended awardees” • CMS to hold discussions with “recommended awardees” • CMS will complete necessary discussions with other federal agencies • Waivers finalized • Sign model agreements • Complete implementation protocols (ex. more detailed gainsharing arrangement) • Start performance period (stipulated in contract)
Brandeis Data Analysis Total allowed amount Scale of 2% discount Distribution of allowed amount Episod e type Cases Period Mean Min 1st 5th 25th Median 75th 95th 99th Max. PNE 221 Index stay 8,619 3,176 3,682 4,638 6,394 7,657 10,492 14,400 16,554 18,527 Number Index % of % of total Episode of Index stay stay Post- Total Medicare hospital type cases (facility) (prof.) discharge episode Dollars inpatient revenue* AMI 203 1,932,162 533,572 3,140,127 5,605,860 112,117 0.17% 0.04% 13,066,31 CHF 476 3,012,750 925,859 9,127,710 9 261,326 0.39% 0.10% COPD 378 2,097,708 557,306 5,743,799 8,398,813 167,976 0.25% 0.06% KNHIP 245 3,014,101 742,620 4,916,876 8,673,597 173,472 0.26% 0.06% PNE 414 2,866,507 714,947 5,580,366 9,161,820 183,236 0.27% 0.07% STR 180 1,305,745 361,156 3,606,874 5,273,775 105,475 0.16% 0.04% SUB- TOTAL 1,896 14,228,97 33,835,460 32,115,75 0 50,180,18 31,003,604 1.48% 0.37% Readm. - Own 585 3,830,444 . . . . . . Readm. - Other 181 1,549,598 . . . . . . Other 49,724,14 Medicare 6,931 1 . . . . . . Total Medicare 9,412 67,783,55 8 . . . . . . Post- Acute 10,525 0 0 0 1,454 5,537 15,800 36,025 57,609 78,708 Total 19,144 4,599 4,963 6,520 10,043 14,200 24,886 45,561 68,811 90,676 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
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Sec. 5506 DGME Slots by State - Fir
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2012 AAMC Annual Meeting Readmissio
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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 and 74: Bundled Payments for Care Improveme
Page 75: AAMC Applicant Organizations • Al
Page 79 and 80: BPCI Lessons Learned To Date • AM
Page 81: Questions??? Additional information
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