CMS releases evaluation of bundled payment program: 5 things to know

CMS has released the second annual evaluation report for Models 2-4 of the Bundled Payments for Care Improvement initiative.

The report, prepared by The Lewin Group, includes both retrospective and prospective bundled payments that may or may not include the acute inpatient hospital stay for a given episode of care. It describes the characteristics of the participants and includes quantitative results from the first year of the initiative (episodes initiated between October 2013 and September 2014).

Across Models 2, 3 and 4, 130 hospitals, 63 skilled nursing facilities, 28 home health agencies and four physician group practices initiated almost 60,000 episodes of care under the BPCI initiative.

The qualitative results reflect participants' experiences through June 2015.

Here are five highlights from the report.

1. CMS said overall 11 out of the 15 clinical episode groups analyzed across Models 2, 3 and 4 showed potential savings to Medicare, although future evaluation reports will have more data to analyze individual clinical episodes within these and additional groups.

2. Average standardized allowed Medicare payments for the hospitalization and 90-days post-discharge were estimated to have declined $864 more for orthopedic surgery episodes initiated at Model 2 hospitals than episodes initiated at comparison hospitals. The decline was attributed to reduced use of institutional post-acute care following the hospitalization. According to the report, beneficiaries who received their care at Model 2 hospitals also indicated they had greater improvement after 90 days post-discharge in two mobility measures than beneficiaries treated at comparison hospitals.

3. For cardiovascular surgery episodes, institutional post-acute care use declined more for BPCI than comparison populations among those with any post-acute care.

4. Among spinal surgery episodes, average Medicare payments increased more for the hospitalization and the 90-day post-discharge period for the BPCI than comparison population.

5. "While there is more work to be done, CMS continues to move forward to achieving the administration's goal to have 50 percent of traditional Medicare payments tied to alternative payment models by 2018," said CMS.

Access the full report here.


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