Bundled payment initiative for providers coming: CMS

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Bundled payment initiative for providers coming: CMS
Bundled payment initiative for providers coming: CMS
Post-acute care providers will be among those affected under a new initiative that will provide bundled Medicare payments.

The Center for Medicare and Medicaid Innovation will oversee the Bundled Payments for Care Improvement initiative, which covers beneficiaries after they are discharged from an acute-care hospital.

The goal is to “align payments for services delivered across an episode of care, such as heart bypass or hip replacement, rather than paying for services separately,” CMS officials note. The program will reward more efficient providers under an Affordable Care Act provision.

The Bundled Payment initiative is based on previous demonstration projects.

An episode of care must be characterized in one of four ways, according to the Innovation Center: Model 1 — as the acute care hospital stay only; Model 2 — the acute care hospital stay, plus post-acute care associated with the stay; Model 3 — just the post-acute care, beginning with the initiation of post-acute care services after discharge from an acute inpatient stay. There is also a fourth model that encompasses all services.

In Models 2 and 3, which would apply to post-acute providers, the process is similar to an accountable care organization: If the expenditures are less than the target price, Medicare will pay the difference to the awardee. If the expenditures are more, the awardee pays the difference to Medicare.

Providers needed to issue a letter of intent by Oct. 6 for Model 1 and by Nov. 4 for Models 2, 3 or 4. Applicants can participate in multiple models. Information on the models is available by searching “Bundled payments” at www.innovations.cms.gov.
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