Deadlines to submit letters of intent for providers that wish to participate in CMS Bundled Payment Initiative are approaching soon. Organizations that wish to participate in Model 1 (a retrospective payment model for acute inpatient care only) must submit a letter of intent to CMS by October 6, 2011, with an application deadline of November 18, 2011. Organizations wishing to participate in the remaining models must submit a letter of intent to CMS by November 4, 2011. The application deadline is March 15, 2012.
CMS is seeking applicants and proposals for the Bundled Payment Initiative that will affect a broad range of categories and conditions, reach many beneficiaries and offer significant savings to Medicare through robust programmatic design. Proposals should involve participation by other payers, be implemented on aggressive timelines and be replicable by similar health systems throughout the nation.
It is important to note that as with any CMS pilot initiative, beneficiary protection is a top priority and nothing in this initiative limits a Medicare beneficiary s right to receive care from the provider of their choosing. Applicants for this pilot may still participate in other CMS programs, including the Medicare Shared Savings Program that creates accountable care organizations. If you are considering participation, the following table defines key features of each of the four models. The complete table can be found on the CMS Fact Sheet.
MODEL/FEATURE
MODEL 1
Inpatient Stay Only
MODEL 2
Inpatient Stay plus Post-discharge Services
MODEL 3
Post-discharge Services Only
MODEL 4
Inpatient Stay Only
Eligible Awardees
Physician group practices
Acute care hospitals
Health systems
Physician-hospital organizations
Conveners of participating health care providers
Physician group practices
Acute care hospitals
Health systems
Physician-hospital organizations
Conveners of participating health care providers
Post-acute providers
Physician group practices
Acute care hospitals
Health systems
Physician-hospital organizations
Conveners of participating health care providers
Long-term care hospitals: Inpatient Rehab, SNFs, Home Health
Physician group practices
Acute care hospitals
Health systems
Physician-hospital organizations
Conveners of participating health care providers
Types of Services Included in Bundle
Inpatient hospital and physician services
Inpatient hospital and physician services
Related post-acute care services
Related readmissions
Other services defined in the bundle
Post-acute care services
Related readmissions
Other services defined in the bundle
Inpatient hospital and physician services
Related readmissions
Payment from CMS to Providers
Acute care hospital: IPPS payment less pre-determined discount
Physician: Traditional fee schedule payment (not included in episode or subject to discount)
Traditional fee-for-service payment to all providers and suppliers, subject to reconciliation with predetermined target price
Traditional fee-for-service payment to all providers and suppliers, subject to reconciliation with predetermined target price
Prospectively established bundled payment to admitting hospital; hospitals distribute payments from bundled payment
Quality Measures
All Hospital IQR measures and additional measures to be proposed by applicants, but CMS will ultimately establish a standardized set of measures that will be aligned to the greatest extent possible with measures in other CMS programs.
If you would like additional information on the Bundled Payment Initiative, please contact the expert listed below at PYA, (800) 270-9629.
Recommended Links:
Visit HealthcareLoop for information you want, the way you want it, on Healthcare Reform
Visit PYA s Healthcare Blog for Healthcare industry insight
Follow us on Twitter @PYAHealthcare
WE ARE REQUIRED BY IRS CIRCULAR 230 TO INFORM YOU THAT THE FOLLOWING DISCUSSION WAS NOT INTENDED OR WRITTEN TO BE USED, AND IT CANNOT BE USED, NOR RELIED UPON,BY ANY TAXPAYER FOR THE PURPOSE OF AVOIDING ANY PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW. THE ADVICE WAS WRITTEN TO SUPPORT THE PROMOTION OR MARKETING OF THE TRANSACTIONS OR MATTERS ADDRESSED IN THE DISCUSSION. EACH TAXPAYER SHOULD SEEK ADVICE BASED ON ITS PARTICULAR CIRCUMSTANCES FROM AN INDEPENDENT TAX ADVISOR.
