Hospitals wanted for test of bundled payment system
Hospitals are being recruited to test the use of a bundled payment system for hospitals and physicians for care delivered through Medicare fee-for-service.
The Centers for Medicare & Medicaid Services (CMS), through its acute care episode (ACE) demonstration, is looking for ways to use a global payment to better align the incentives for both types of providers leading to better quality and greater efficiency in the care that is delivered. The demonstration also will test the effect that transparent price and quality information has on beneficiary choice and provider referrals for select inpatient care.
"CMS expects to demonstrate how to not only better coordinate inpatient care, but to also achieve savings in the delivery of that care that can ultimately be shared between providers, beneficiaries, and Medicare," said CMS Acting Administrator Kerry Weems.
CMS plans to competitively award only one ACE demonstration site per market area during the first year of the demonstration. Each demonstration site, or "Value-Based Care Center," will be selected and actively marketed by CMS to both beneficiaries and referring physicians.
For purposes of this demonstration, a bundled payment is a single payment for both Part A and Part B Medicare services furnished during an inpatient stay. Currently, CMS generally pays the hospital a single prospectively determined amount under the Inpatient Prospective Payment System (IPPS) for all the care it furnishes to the patient during an inpatient stay. The physicians who care for the patient during the stay are paid separately under the Medicare Physician Fee Schedule for each service they perform. The separate payment systems can lead to conflicting incentives that may affect decisions about what care will be provided.
The select sets of procedures included in the bundled payment demonstration are 28 cardiac and 9 orthopedic inpatient surgical services. These elective procedures were selected because profit margins and volume have historically been high; there is sufficient marketplace competition to ensure interested demonstration applicants; the services are easy to specify, and quality metrics are available for them.
This demonstration provides an opportunity for Value-Based Care Centers to develop efficiencies in the care they provide to beneficiaries through increasing market share, quality improvement in clinical pathways, improved coordination of care among specialists, and "gainsharing." Gainsharing, or provider incentive programs, allow physicians and hospitals to share remuneration for implementing and coordinating improvements in efficiency and quality.
More information can be found by going to www.cms.hhs.gov; click the "Medicare" tab in the upper left of the screen.
Hospitals are being recruited to test the use of a bundled payment system for hospitals and physicians for care delivered through Medicare fee-for-service.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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