CMS extends participation in the Bundled Payments for Care Improvement initiative

The more than 1,500 healthcare providers taking part in the Bundled Payments for Care Improvement initiative may extend their participation in Models 2, 3 and 4 through September 30, 2018, according to the Centers for Medicare and Medicaid Services.

Participation was originally scheduled to end on September 30. The extension allows organizations, including those that joined later in 2014, to participate for another two years.

CMS said it would use the additional time to evaluate whether the effort to bundle payments is successful in providing better care while saving money.

[Also: CMS launches bundled payment test for joint replacement]

As of April 1, there were 1,522 participants in the Bundled Payments for Care Improvement initiative.

In Models 2, 3 and 4, participants may choose from among 48 clinical episodes when considering their opportunities for care redesign, improving quality, and achieving savings, CMS said.

Models 2 and 3 are a retrospective bundled payment in which actual expenditures are reconciled against a target price for an episode of care.

[Also: Truven Health finds $10,000 regional difference in bundled spending for joint replacement]

The bundle for Model 1 includes all non-hospice Part A and B services during the initial inpatient stay, post-acute period and readmissions.

Model 3 it includes all non-hospice Part A and B services during the post-acute period and readmissions.

In Model 4, CMS makes a single bundled payment to the hospital for all services furnished by the facility, physicians and other practitioners during an episode of care for the entire inpatient stay. It includes bundles for all non-hospice Part A and B services from the hospital and physician during initial inpatient stay and readmissions.

Model 1 is for an episode of care for an inpatient stay in the acute care hospital. Medicare pays the hospital a discounted amount based on the payment rate in the Inpatient Prospective Payment System used in the original Medicare program. Physicians are paid separately under the Physician Fee Schedule. Participation concludes on December 31.

Bundling payment for services that patients receive across a single episode of care – such as a heart bypass surgery or a hip replacement – is one way to encourage doctors, hospitals and other healthcare providers to work together to better coordinate care for patients, both when they are in the hospital and after they are discharged, said Patrick Conway, acting principal deputy administrator and chief medical officer for CMS. 

Twitter: @SusanJMorse