Policy & Regulation News

CMS Adds Pilot Project Participants to Reduce Medicare Costs

By Jacqueline DiChiara

- The Centers for Medicare & Medicaid Services (CMS) has announced over 2,100 acute care hospitals, skilled nursing facilities, physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies shifted to a risk-bearing implementation period where financial risk for episodes of care was assumed from a preparatory period.

Bundled Payments for Care Improvement initiative

1,755 providers have already partnered with those organizations. 360 other organizations have agreed to participate in CMS’s Bundled Payments for Care Improvement initiative (BPCI) where four episode-based payment models bundle payments for multiple services beneficiaries receive during a care episode.

According to CMS, an episode of care is “the set of services provided to treat a clinical condition or procedure, such as a heart bypass surgery or a hip replacement.” Says CMS, bundling payment for services patients receive across a single care episode promotes better coordinated care and urges physicians, hospitals, and healthcare providers to more strongly collaborate.

CMS is testing how bundled payments for clinical episodes help manifest more economically sound spending and advanced care via BPCI, which includes four models of bundled payments connected to inpatient hospital admission that vary according to provider type and post-hospitalization bundle length.

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  • “We are excited that thousands of providers in the Bundled Payments for Care Improvement initiative have joined us in changing the health care system to pay for quality over quantity - spending our dollars more wisely and improving care for Medicare beneficiaries,” says Patrick Conway, MD, CMS Acting Principal Deputy Administrator and Chief Medical Officer. “By focusing on outcomes for an episode of care, rather than separate procedures in care delivery, we are incentivizing hospitals, doctors and other providers to work together to provide high quality, coordinated care for patients.”

    CMS also recently announced the Comprehensive Care for Joint Replacement Model, a new Medicare Part A and B payment model. As RevCycleIntelligence.com reported, this innovation may be a promising step toward rewarding value over volume and treating patients more like families during their healthcare decision-making endeavors. As CMS confirmed, such initiatives grant healthcare providers with an increased sense of flexibility with the bundling of conditions, developing the healthcare delivery structure, and considering payment allocation among healthcare providers.

    “Although the Comprehensive Care for Joint Replacement Model is distinct from the Bundled Payments for Care Improvement initiative, both initiatives are part of the innovative framework established by the Affordable Care Act to move our health care system toward one that rewards providers based on the quality, not quantity, of care they deliver to patients,” confirms CMS in relation to its goal to tie 30 percent of Medicare payments to quality and value via alternative payment models by next year and 50 percent of payments within the next three years.