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Mixed results from CMS’s orthopedic bundle initiative


The CMS has released its second annual evaluation for Models 2-4 of the Bundled Payments for Care Improvement (BPCI) initiative, which details the results from the first year of the initiative, which, for now, involves orthopedic surgery.

Patrick Conway, M.D., CMS’s acting principal deputy administrator and chief medical officer, called the results for orthopedic-surgery bundles encouraging, noting that under Model 2, participating hospitals were shown to have achieved statistically significant savings of $864 per episode while improving quality.

To read Dr. Conway’s remarks, please hit this link.

But, the report also showed that average payments for spinal-surgery episodes rose $3,477 more compared to the increase among nonbundling providers.

HealthcareDIVE commented:

“While the report stresses additional future analyses will be required to estimate any overall savings impact to Medicare, the CMS highlighted its optimism that 11 out of the 15 clinical episode groups that were analyzed did show indicators for potential savings.

“As more data become available over the next year and beyond, upcoming reports will be able to better estimate the BPCI initiative’s impacts on both costs and quality. This report, prepared by The Lewin Group, was the second of five planned annual reports. It looked at the experiences of Phase 2 participants in the first year of the initiative, in which episodes were initiated between October 2013 and September 2014. The report’s qualitative results reflect participants’ experiences through June 2015, the researchers said, noting that participation has continued to grow since, with more providers entering Phase 2 in April and July 2015.’’

To read the HealthcareDIVE analysis, please hit this link.

Meanwhile, CMS is moving ahead developing  additional bundled-payment models. Hit this link to look at one such model — cardiology. 

CMS offers 2-year extension for bundled-payment program


CMS is  offering participants in the Bundled Payments for Care Improvement initiative the option to extend participation an additional two years, says a blog post from Patrick Conway, M.D., CMS’s acting principal deputy administrator and chief medical officer.

Rather than ending the program this fall, participating providers can extend participation through Sept. 30, 2018.

Becker’s Hospital Review says that the agency hopes that “the extension will help it better determine the effectiveness of the program, which aims to incentivize providers to improve care coordination by paying for services patients receive across an episode of care, such as a heart bypass surgery or hip replacement.”

Dr. Conway wrote: “By extending their participation, CMS will be able to provide a more robust and rigorous evaluation of the initiative and determine whether the efforts of bundling payments are successful in providing better care while spending healthcare dollars more wisely”.

The initiative tests four payment models, which vary based on the services in the episode of care and whether payments are made prospectively or retrospectively. BPCI has 1,522 participants, nearly all of which are in Models 2, 3 and 4.

The extension will be available to providers in Models 2, 3 and 4 that began the BPCI initiative in October 2013 or in 2014.

CMS: Ahead of pay-for-performance goal


Obama administration officials said Thursday  that they were almost a year ahead of their target to change how Medicare pays hundreds of billions of dollars to providers each year.

The Centers for Medicare &  Medicaid Services has sought to make  30 percent of its payments to clinicians and hospitals  be on the basis of the quality of care they provide, rather than the quantity, by the end of 2016, with the aim of hitting 50 percent by 2018.

Patrick Conway, M.D., the chief  CMS medical officer,  said Thursday that the 30 percent goal had been met as of January 2016. The agency estimated  that about  $117 billion out of a projected $380 billion  in Medicare fee-for-service payments for the year were going to providers  participating in pay-for-performance programs.

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