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Tags Posts tagged with "Bundled Payments for Care Improvement"

Bundled Payments for Care Improvement

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Due to the increase in joint replacement surgeries and the prediction for these surgeries to become more prevalent by 2025, along with the implementation of the Bundled Payments for Care Improvement (BPCI) initiative, a request has been made by the Agency for Healthcare Research and Quality (AHRQ) for feedback on Pre-rehabilitation and Rehabilitation for joint replacement surgery. AHRQ is specifically seeking this information because decision makers are unclear about which pre-rehabilitation (e.g., resistance and proprioceptive training) and rehabilitation interventions (e.g., rehabilitation hospitalization, home physical therapy, or outpatient physical therapy) provide the most optimal patient outcomes with the most efficient use of resources. There is also discussion over the settings where these interventions provide the most value. Because of this uncertainty, a new systemic review on the effects of pre-rehabilitation and rehabilitation for major joint replacement surgery may be warranted.

RCPA encourages members to provide feedback to the key questions. The deadline to provide feedback is Friday, January 17, 2020.

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In July 2016, the Centers for Medicare and Medicaid Services (CMS) proposed new bundled payment models to shift Medicare payments from rewarding quantity to rewarding quality by creating strong incentives for hospitals and clinicians to deliver better care to patients at a lower cost. These proposed new bundled payment models focus on heart attacks, heart bypass surgery, and hip fracture surgery, and would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery. This proposal follows the implementation of the Comprehensive Care for Joint Replacement (CCJR) Model that began earlier this year which introduced bundled payments for certain hip and knee replacements.

CMS just released the second annual evaluation report for Models 2–4 of the Bundled Payments for Care Improvement (BPCI) Initiative, which include both retrospective and prospective bundled payments that may or may not include the acute inpatient hospital stay for a given episode of care. This report describes the characteristics of the participants and includes quantitative results from the first year of the initiative. Key highlights include:

  • 11 out of the 15 clinical episode groups analyzed showed potential savings to Medicare. Future evaluation reports will have more data to analyze individual clinical episodes within these and additional groups;
  • Orthopedic surgery under Model 2 hospitals showed statistically significant savings of $864 per episode while showing improved quality as indicated by beneficiary surveys. Beneficiaries who received their care at participating hospitals indicated that they had greater improvement after 90 days post-discharge in two mobility measures than beneficiaries treated at comparison hospitals; and
  • Cardiovascular surgery episodes under Model 2 hospitals did not show any savings yet but quality of care was preserved. Over the next year, we will have significantly more data available, enabling CMS to better estimate effects on costs and quality.