PPACA: CMS to Test Payment Models

CMS officials report that earlier bundled care pilot programs seemed to cut the cost of care about 5% to 10%.

The four models to be tested in 2012 are:

• Model 1: “Hospital services provided to a beneficiary during an acute inpatient stay, where physicians are partners in improving care.”
• Model 2: “Hospital, physician, post-acute provider, and other Medicare-covered services provided during the inpatient stay as well as during recovery after discharge to the home or another care setting.”
• Model 3: “Hospital, physician, post-acute provider, and other Medicare-covered services beginning with the initiation of post-acute care services after discharge from an acute inpatient stay.”
• Model 4: “Prospective Payment Bundling… CMS would make a single, prospectively determined bundled payment to the hospital that would encompass all services furnished during the inpatient stay by the hospital, physicians and other practitioners. Physicians and other practitioners would submit ‘no-pay’ claims to Medicare and would be paid by the hospital out of the bundled payment.”

Providers that want to help test Model 1 must submit letters of intent to participate by Sept. 22.

Letters of intent for the other models are due Nov. 4.

CMS is giving providers that want to try models 2, 3 and 4 more time because they must provide historical Medicare claims data, officials say.

Private health plans and health insurers will not participate in the bundled payments program, but policymakers are hoping that, if CMS comes up with any successful strategies for holding down costs, other payers will follow suit.

Other provider reimbursement coverage from National Underwriter Life & Health:

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• The Medical Home: Dream Castle Or Just A Buzzword?
• Primary Care Gap Affects Bay State Reforms
• CMS Unveils ACO Draft
• PPACA: Feds Seek ACO, Review Comments