Under the Bundled Payments for Care Improvement initiative, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare.
Under Model 4, CMS will 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 will submit “no-pay” claims to Medicare and will be paid by the hospital out of the bundled payment. Related readmissions for 30 days after hospital discharge will be included in the bundled payment amount. Participants can select up to 48 different clinical condition episodes.
Participating Organizations
There are 75 health care facilities (Map | List) represented by the following 37 Model 4 participants:
- Bronson Methodist Hospital (Kalamazoo, MI)
- CHRISTUS Santa Rosa Health Care Corporation (San Antonio, TX)
- Florida Hospital (Orlando, FL)
- Glendale Memorial Hospital and Health Center (GMHHC), Dignity Health (Glendale, CA) This participant is a convener of health care facilities in CA
- Meridian Hospital Corporation, Jersey Shore University Medical Center (Neptune, NJ)
- Lancaster General Hospital (Lancaster, PA)
- Mercy Medical Center (Canton, OH)
- Methodist Hospital of Southern California (Arcadia, CA)
- Missouri Baptist Medical Center (St. Louis, MO)
- Northridge Hospital Medical Center (Northridge, CA)
- Pomona Valley Hospital Medical Center (Pomona, CA)
- Providence Hospitals (Columbia, SC)
- Rothman Specialty Hospital (Bensalem, PA)
- Shore Memorial Hospital (Somers Point, NJ)
- Sparrow Hospital (Lansing, MI)
- St. Joseph's Hospital & Medical Center (SJHMC), member of Dignity Health (Phoenix, AZ)
- St. Luke's Hospital (Chesterfield, MO)
- St. Mary Medical Center (Dignity) (Long Beach, CA )
- Sutter Medical Center Sacramento (Sacramento, CA)
- NewYork-Presbyterian Hospital (New York, NY )
- Torrance Memorial Medical Center (Torrance, CA)
- Crozer-Chester Medical Center (Upland, PA)
- Delaware County Memorial Hospital (Drexel Hill , PA)
- Baptist Medical Center (San Antonio, TX)
- St. Rose Dominican Hospitals (Henderson, NV) This participant is a convener of health care facilities in NV
- Health Management Associates (Naples, FL) This participant is a convener of health care facilities in FL, OK, TN, AR
- Health Quest Systems, Inc. (LaGrangeville, NY) This participant is a convener of health care facilities in NY
- Sisters of Charity of Leavenworth Health System/Exempla, Inc. (Denver, CO) This participant is a convener of health care facilities in CO, KS, MT
- North Shore LIJ Health Care Inc (Great Neck, NY) This participant is a convener of health care facilities in NY
- Summa Health System (Akron, OH) This participant is a convener of health care facilities in OH
- Scottsdale Healthcare Corporation (Scottsdale, AZ) This participant is a convener of health care facilities in AZ
- Tenet Healthcare Corporation (Dallas, TX) This participant is a convener of health care facilities in CA, MO, TN
- ScrippsCare (San Diego, CA) This participant is a convener of health care facilities in CA
- Abrazo Region Services (Phoenix, AZ) This participant is a convener of health care facilities in AZ
- Valley Baptist Health System (Harlingen, TX) This participant is a convener of health care facilities in TX
- Association of American Medical Colleges (Washington, DC) This participant is a convener of health care facilities in CA, CO
- Integrated Healthcare Association (Oakland, CA) This participant is a convener of health care facilities in CA
Background
Medicare currently makes separate payments to providers for the services they furnish to beneficiaries for a single illness or course of treatment, leading to fragmented care with minimal coordination across providers and health care settings. Payment is based on how much a provider does, not how well the provider does in treating the patient.
Research has shown that bundled payments can align incentives for providers – hospitals, post acute care providers, doctors, and other practitioners – to partner closely across all specialties and settings that a patient may encounter to improve the patient’s experience of care during a hospital stay in an acute care hospital, and during post-discharge recovery.
On January 31, 2013 Phase 1 participants were announced. Phase 1 (January-July 2013), also referred to as the “no risk preparation” period, is the initial period of the initiative, where CMS and participants prepare for implementation and assumption of financial risk. All candidates included in Phase 1 submitted a final list of their episodes and planned partners in December 2012.
The “risk-bearing implementation” period, Phase 2, is expected to begin in July 2013. Those participants in Phase 1 of Models 2, 3, and 4, that are ultimately approved by CMS and decide to move forward with implementation and assume financial risk, may enter into a Bundled Payments for Care Improvement Model agreement with CMS and begin Phase 2 of the Model.
Phase 2 is expected to begin in July 2013. The beginning of Phase 2 would mark the beginning of the performance period, or risk-bearing period.
Additional Information
