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Affordable Care Act Bundled Hospital Payments

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  • Melinda
    http://www.hhs.gov/news/press/2011pres/08/20110823a.html News Release FOR IMMEDIATE RELEASE August
    Message 1 of 2 , Aug 30, 2011
      <http://www.hhs.gov/news/press/2011pres/08/20110823a.html> News Release

      August 23, 2011

      Contact: HHS Press Office
      (202) 690-6343

      Affordable Care Act initiative to lower costs, help doctors and
      hospitals coordinate care
      The U.S. Department of Health and Human Services (HHS) today announced a
      new initiative to help improve care for patients while they are in the
      hospital and after they are discharged. Doctors, hospitals, and other
      health care providers can now apply to participate in a new program
      known as the Bundled Payments for Care Improvement initiative (Bundled
      Payments initiative). Made possible by the Affordable Care Act, it will
      align payments for services delivered across an episode of care, such as
      heart bypass or hip replacement, rather than paying for services
      separately. Bundled payments will give doctors and hospitals new
      incentives to coordinate care, improve the quality of care and save
      money for Medicare.

      "Patients don't get care from just one person – it takes a
      team, and this initiative will help ensure the team is working
      together," said HHS Secretary Kathleen Sebelius. "The Bundled
      Payments initiative will encourage doctors, nurses and specialists to
      coordinate care. It is a key part of our efforts to give patients better
      health, better care, and lower costs."

      In Medicare currently, hospitals, physicians and other clinicians who
      provide care for beneficiaries bill and are paid separately for their
      services. This Centers for Medicare & Medicaid Services (CMS)
      initiative will bundle care for a package of services patients receive
      to treat a specific medical condition during a single hospital stay
      and/or recovery from that stay – this is known as an episode of
      care. By bundling payment across providers for multiple services,
      providers will have a greater incentive to coordinate and ensure
      continuity of care across settings, resulting in better care for
      patients. Better coordinated care can reduce unnecessary duplication of
      services, reduce preventable medical errors, help patients heal without
      harm, and lower costs.

      The Bundled Payments initiative is being launched by the new Center for
      Medicare and Medicaid Innovation (Innovation Center), which was created
      by the Affordable Care Act to carry out the critical task of finding new
      and better ways to provide and pay for health care to a growing
      population of Medicare and Medicaid beneficiaries.

      Released today, the Innovation Center's Request for Applications
      (RFA) outlines four broad approaches to bundled payments. Providers
      will have flexibility to determine which episodes of care and which
      services will be bundled together. By giving providers the flexibility
      to determine which model of bundled payments works best for them, it
      will be easier for providers of different sizes and readiness to
      participate in this initiative.

      "This Bundled Payment initiative responds to the overwhelming calls
      from the hospital and physician communities for a flexible approach to
      patient care improvement," said CMS Administrator Donald Berwick,
      M.D. "All around the country, many of the leading health care
      institutions have already implemented these kinds of projects and seen
      positive results."

      The Bundled Payments initiative is based on research and previous
      demonstration projects that suggest this approach has tremendous
      potential. For example, a Medicare heart bypass surgery bundled payment
      demonstration saved the program $42.3 million, or roughly 10 percent of
      expected costs, and saved patients $7.9 million in coinsurance while
      improving care and lowering hospital mortality.

      "From a patient perspective, bundled payments make sense. You want
      your doctors to collaborate more closely with your physical therapist,
      your pharmacist and your family caregivers. But that sort of common
      sense practice is hard to achieve without a payment system that supports
      coordination over fragmentation and fosters the kinds of relationships
      we expect our health care providers to have," said Dr. Berwick.

      Organizations interested in applying to the Bundled Payments for Care
      Improvement initiative must submit a Letter of Intent (LOI) no later
      than September 22, 2011 for Model 1 and November 4, 2011 for Models 2,
      3, and 4. For more information about the various models and the
      initiative itself, please see the Bundled Payments for Care Improvement
      initiative web site at:
      ed-payments-for-care-improvement.html> .

      To view a factsheet on the Bundled Payments for Care Improvement
      initiative visit

      Interested parties may obtain answers to specific questions by e-mailing
      CMS at: BundledPayments@... <mailto:BundledPayments@...>

      This initiative is part of a broader effort by the Obama Administration
      to improve health, improve care, and lower costs. A brief summary of
      other efforts, including those authorized by the Affordable Care Act,
      can be found at:

      For more information about the CMS Innovation Center, please visit:
      http://www.innovations.cms.gov <http://www.innovations.cms.gov/> .
      Applicants for these models would also decide whether to define the
      episode of care as the acute care hospital stay only (Model 1), the
      acute care hospital stay plus post-acute care associated with the stay
      (Model 2), or just the post-acute care, beginning with the initiation of
      post-acute care services after discharge from an acute inpatient stay
      (Model 3). Under the fourth model, CMS would make a single, prospective
      bundled payment that would encompass all services furnished during an
      inpatient stay by the hospital, physicians and other practitioners.

      Interested organizations must submit a nonbinding letter of intent by
      September 22, 2011 for Model 1 and November 4, 2011 for Models 2-4 as
      described in the Bundled Payments for Care Improvement initiative RFA.
      For applicants wishing to receive historical Medicare claims data in
      preparation for Models 2-4, a separate research request packet and data
      use agreement must be filed in conjunction with the Letter of Intent.
      Final applications must be received on or before October 21, 2011 for
      Model 1 and March 15, 2012 for Models 2-4.


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    • Melinda
      Message 2 of 2 , Aug 30, 2011
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