CMS has reopened the opportunity for proposals in its bundling initiative for Models 2, 3, and 4. This is due in part as to obtain a larger number of bundling demonstrations going as well as a wider variety of proposals.
Models 2 and 3 involve post-acute care services.
NAHC encourages home health agencies to consider developing a proposal for the bundling initiative, as there is a significant push in health care policy to advance post-acute care bundling as a model of payment for the future. Home healthcare is likely to be the beneficiary of that push as it can provide comparable care in the community that is much less expensive than institutional care
As part of the Affordable Care Act, authorized the CMS Innovation to test innovative payment and service delivery models that reduce spending under Medicare, Medicaid, or CHIP, while preserving or enhancing the quality of care. Consistent with that authority, CMS seeks to achieve the following goals:
- Improve care coordination, beneficiary experience, and accountability in a person-centered manner.
- Support and encourage providers that are interested in continuously reengineering care to deliver better care and better health at lower costs through continuous improvement.
- Create a cycle that leads to continually decreasing the cost of an acute or chronic episode of care while fostering quality improvement.
- Develop and test payment models that create extended accountability for better care, better health at lower costs for the full range of health care services.
- Shorten the cycle time for adoption of evidence-based care.
- Create environments that stimulate rapid development of new evidence-based knowledge.
CMS is committed to achieving better health, better care, and lower costs through continuous improvement for Medicare, Medicaid and Children's Health Insurance Program (CHIP) beneficiaries. Beneficiaries can experience improved health outcomes and encounters in the health care system when providers work in a coordinated and person-centered manner. To this end, CMS is interested in partnering with providers that are working to redesign care to meet these goals. Payment approaches that reward providers that assume payment accountability for a particular “episode” of care are potential mechanisms for developing these partnerships.
The Innovation Center is testing four episode payment models through the Bundled Payments for Care Improvement initiative. The current participants in the initiative were selected following a review of the applications submitted in response to a Request for Application, http://innovation.cms.gov/Files/x/Bundled-Payment-Request-for-Application.pdf released by the Innovation Center in August 2011.
On January 31, 2013, the first set of BPCI Phase 1 participants were announced. Phase 2 began either on October 1, 2013 or January 1, 2014 for Awardees that have entered into Model 2 Awardee Agreements with CMS, at which point Awardees began the risk-bearing phase for some or all of their episodes. The complete transition of all episodes for all episode initiators to Phase 2 will be completed by October 2014. During the transition period, Awardees may transition episodes and/or Episode Initiators that have remained in Phase 1 to Phase 2 on a quarterly basis.
Phase 2 of Models 2 through 4 began testing in October 2013. Models 2, 3, and 4 are described as follows:
- Model 2—Retrospective bundled payment models for hospitals,physicians, and post-acute providers for an episode of care consisting of an inpatient hospital stay followed by post-acute care.
- Model 3—Retrospective bundled payment models for post-acute care where the episode does not include the acute inpatient hospital stay.
- Model 4—Prospectively administered bundled payment models for the acute inpatient hospital stay and related readmissions.
image attribtution from The Hospitalist