#Cms mus2 core 2015 update plus

Phase 1 participants transitioned to Phase 2 вЂ“ the вЂњrisk-bearingвЂќ period вЂ“ upon execution of an agreement with CMS. Phase 1 вЂ“ the вЂњpreparationвЂќ period вЂ“ was the initial period of the initiative during which CMS and participants prepared for implementation and participant assumption of financial risk. The Bundled Payments for Care Improvement initiative included two phases for Models 2, 3, and 4. Models 2, 3 and 4 вЂ“ Two Phased Implementation The remaining Awardee concluded their participation on December 31, 2016. The first cohort of Awardees in Model 1 began in April 2013 and concluded March 31, 2016. In the summer of 2013, CMS allowed organizations to submit new requests to participate in BPCI Model 1, and one new Awardee began participating in January 2014. On January 31, 2013, CMS announced the selection of Model 1 Awardees, and participation began in April 2013. Model 1 Awardees participated in BPCI episodes for all MS-Diagnosis-Related Groups (DRG) for eligible beneficiaries.ДЄpplications to participate in Model 1 were due in November 2011. Medicare paid physicians separately for their services under the Medicare Physician Fee Schedule. Medicare paid the hospital a discounted amount based on the Inpatient Prospective Payment System payment rates used in the original Medicare program. In Model 1, the episode of care was defined as an inpatient stay in an acute care hospital. BPCI Model 1: Acute Care Hospital Stay Only The first cohorts of Awardees in Models 2, 3, and 4 began in October 2013. Physicians and other practitioners submitted вЂњno-payвЂќ claims to Medicare and were paid by the hospital out of the bundled payment. In Model 4, CMS made a single, prospectively determined bundled payment to the hospital that encompassed all services furnished by the hospital, physicians, and other practitioners during the episode of care, which lasted the entire inpatient stay. Medicare then made a payment or recoupment amount that reflected the aggregate expenditures compared to the target price. Under these retrospective payment models, Medicare continued to make fee-for-service (FFS) payments CMS later reconciled the total expenditures for the episode against a bundled payment amount (the target price).

In Model 3, the episode of care was triggered by an acute care hospital stay but began at initiation of post-acute care services with a skilled nursing facility, inpatient rehabilitation facility, long-term care hospital, or home health agency.

#Cms mus2 core 2015 update plus

In Model 2, the episode included the inpatient stay in an acute care hospital plus the post-acute care and all related services up to 90 days post-hospital discharge. Model 2 and Model 3 consisted of a retrospective bundled payment arrangement where actual expenditures were reconciled against a target price for an episode of care.

The first cohort of Awardees in Model 1 began in April 2013 and concluded on March 31, 2016. Medicare continued to pay physicians separately for their services under the Medicare Physician Fee Schedule. Medicare paid the hospital a discounted amount based on the payment rates established under the Inpatient Prospective Payment System used in the original Medicare program. In Model 1, the episode of care was defined as the inpatient stay in the acute care hospital. The Center for Medicare and Medicaid Innovation (Innovation Center) developed the BPCI Initiative in order to assess whether the models tested resulted in improved patient care and lower costs to Medicare. BPCI Episode Initiators include acute care hospitals, skilled nursing facilities, physician group practices, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals that trigger an episode of care. Episode Initiators are health care providers that trigger BPCI episodes of care they do not bear risk directly (unless they also serve as an Awardee) but participate in the model through an agreement with a BPCI Awardee. In BPCI, an Awardee is the entity that assumes financial liability for the episode spending. Research has shown that bundled payments can align incentives for providers вЂ“ hospitals, post-acute care providers, physicians, and other practitioners вЂ“ allowing them to work closely together across all specialties and settings. Payment rewards the quantity of services offered by providers rather than the quality of care furnished. This approach can result in fragmented care with minimal coordination across providers and health care settings. Traditionally, Medicare makes separate payments to providers for each of the individual services they furnish to beneficiaries for a single illness or course of treatment.