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Brandeis Data Analysis Mean allowed amount Cases with readmission Cases with office visit in 30 days Cases with ED visit Episode type Number of cases Index stay (facility) Index stay (prof.) Postdischarge Total Episode Cases Rate Cases Rate Cases Rate AMI 70 7,127 2,358 12,769 22,253 23 32.90% 31 44.30% 11 15.70% CHF 192 5,785 1,577 15,372 22,734 72 37.50% 75 39.10% 37 19.30% COPD 210 5,077 1,183 10,999 17,260 57 27.10% 134 63.80% 43 20.50% KNHIP 147 11,512 2,937 16,762 31,212 11 7.50% 39 26.50% 5 3.40% PNE 242 6,174 1,651 12,250 20,074 55 22.70% 117 48.30% 32 13.20% STR 61 6,711 1,805 22,038 30,554 11 18.00% 16 26.20% 15 24.60% Cases with one or more readmissions Readmissions by location Readmit per Episod e types Cases Rate Cases 1 2 3 4+ Readmits case with readmit Own Other AMI 203 31.5% 64 43 18 3 0 88 1.38 57 31 CHF 476 39.9% 190 122 39 12 17 317 1.67 232 85 COPD 378 33.6% 127 89 25 7 6 184 1.45 158 26 KNHIP 245 13.1% 32 26 6 0 0 38 1.19 34 4 PNE 414 20.3% 84 69 12 2 1 103 1.23 84 19 STR 180 15.6% 28 22 4 2 0 36 1.29 20 16 2012 AAMC Annual Meeting
BPCI Lessons Learned To Date • AMCs know what bundles to pursue • The data serves to reinforce clinical judgment, not necessarily to change plans • Chronic conditions tend to be more costly with higher readmit rates, and are messier to bundle • There are many reasons hospitals choose not to participate, including a variety of clinical and organizational factors • Literature on evidence-based practices in care redesign is limited • Bundling requires new relationships with providers and PAC, these relationships bring new operational challenges 79 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
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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 and 76: AAMC Applicant Organizations • Al
Page 77: Brandeis Data Analysis Total allowe
Page 81: Questions??? Additional information
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Hospitals

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