In the latest move to shift Medicare reimbursements to at-risk, quality-focused payment models, the Department of Health & Human Services (HHS) proposed new episode-based bundles, which are scheduled to launch in 2017. Here are the top ten things you should know:
The following is an example provided by CMS* to illustrate how the new payment model will work for coronary bypass surgery episodes in model years four and five were the average cost for an episode of care is $50,000:
"Hospital A is performing at the highest overall level on quality measures and its discount rate is 1.5 percent for the episode. As a result, its quality-adjusted target price for bypass surgery is $49,250 (or $50,000 minus the discount of $750). By taking measures to avoid readmissions and other unnecessary costs, Hospital A is able to reduce average total hospitalization and related 90-day post-discharge costs for bypass surgery patients to $48,000. Hospital A would be paid average savings of $1,250 per patient.
Hospital B in the same region also reduces its average costs to $48,000 per patient. However, it achieves only acceptable overall performance on quality measures. Its discount rate is 3 percent and its quality-adjusted target price is $48,500 (or $50,000 minus the discount of $1,500). Hospital B would be paid average savings of only $500 per patient.
For additional details and to learn more, please visit the CMS Episode Payment Models: General Information page located here.
*Episode Payment Models. General Information. Centers for Medicare & Medicaid Services; Last updated on: 07/29/2016.
- By Jvion Health