Clear Evidence that Bundles Are Here to Stay
Last week’s announcement for mandated bundled payments in cardiac care is further evidence that this administration intends to accelerate its promise for Episode Payment Models (EPMs) and Alternative Payment Models (APMs) to reach the goal of 50% of Medicare beneficiaries in value based care models by 2018. With these new announcements and past announcements such as the Comprehensive Care for Joint Replacement model (CJR), Comprehensive Primary Care Plus model (CPC+) and Oncology Care Model (OCM), this goal will likely be achieved before 2018.
Here are the facts:
* New bundled payment models have been announced for cardiac care, acute myocardial infarction (AMI), and coronary artery bypass grafting (CABG) surgeries as well as an extension of CJR for hip surgeries.
* July 1, 2017 is the start date for performance years.
* 98 MSAs will be selected from qualifying MSAs – see Are You On The Map to find your county.
* Target pricing is similar to CJR.
* A new model to increase cardiac rehabilitation utilization.
* 10 quality measures are used to create a composite score to earn back increases in target price.
* Minimum quality thresholds must be met for gain share.
* Waivers for Medicare requirements are being used to encourage development of novel approaches.
Many of you may be feeling overwhelmed by this speed and are just trying to figure out how to spell MACRA (Medicare Access & CHIP Reauthorization Act) let alone really understand the impact that these new value-based care models will have on increasing quality and lowering costs. It is my opinion that this is one of the best uses of CMS and CMMI funds because it will cause broad and swift changes necessary to move the incentives from our broken payment system.
I commend those providers that voluntarily participate in ACOs and the Bundled Payments for Care Improvement Initiative (BPCI). In order to motivate a complex system with many actors and fragmented continuity of care, we need to impose new models that can reward best practices and remediate systems that are not performing.
I have been fortunate to see this happen twice in my career thus far. The first time was as Executive Director of the National ePrescribing Patient Safety Initiative (NEPSI), a program sponsored by Allscripts to give away ePrescribing. We tried to give the technology away, but this didn’t move the needle until CMS stepped up. Starting with additional 2% reimbursement for total Medicare claims to a final 2% reduction, CMS’s carrot and stick incentives drove adoption much more successfully than even giving the technology away could.
The second evidence of incentives creating real change that I experienced was EHR adoption and Meaningful Use. Whether you agree with the incentive or feel the reimbursement was a joke for providers who spent magnitudes more to go electronic, the system has now changed, and we are seeing the benefits of reduced paper. To name a few examples, we can now use population health data to risk stratify our patients better, implement comparative effectiveness, and create richer longitudinal clinical charts with digital access to information.
What has also happened since ACA is the increased use of technology to satisfy these new requirements. We can’t implement these new models with more people. It’s simply impossible to hire enough care managers to monitor every patient, every day. Fortunately, CMS has included waivers in both CJR and the newly announced bundles that waive restrictions for telehealth and the Stark law to encourage the use of patient engagement technology and services.
Automated patient engagement solutions like HealthLoop that show meaningful reduction in readmissions and complications can be used by systems to monitor patients no matter where they are in the continuity of care. These technologies can be used to help discharge more patients to home and deliver care in the safest place to recover. Along the way, Patient Reported Outcomes (PROs) can be collected to determine the effectiveness of treatments.
Platforms like this help to manage at-risk patients who may have a potential treatment failure when they most need help. This creates efficiencies with care management teams that can do exception-based outreach to patients instead of phone-based outreach to try and connect with all patients.
I am sure we will see new innovative and emerging technologies implemented by health systems feeling the financial pain of mandated bundled payments. Ultimately, these new care models will benefit the patient the most. Turns out, patients want to get better; they don’t want complications or readmissions. They just need to have the right tools with an empathetic system to help them be more engaged and empowered.
Click here to find out more about this bundled payment framework with helpful resource links.
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