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Find videos, learning materials, case studies and tools designed to assist you in navigating the often-
complex process of implementing bundled payment programs in your local healthcare settings.

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How ‘Home-to-Home Time’ Supports the Goals of Bundled Payments

Addressing the tendency of fee-for-service to promote more spending requires changing the metrics that motivate clinician behavior away from volume as a primary focus. The DRG system, an early example of bundled payment, represents an attempt to solve the problem by paying hospitals a set amount for each hospitalization. DRG-based reimbursement incentivizes hospitals to keep costs down by eliminating unnecessary services and by shortening length of stay (LOS). Indeed, in the 30 years following the introduction of the DRG system, average hospital LOS nearly halved, dropping from 10.0 days in 1983 to 5.1 days in 20131,2

This fix may have had unintended consequences. After adjusting their practices to discharge patients home as soon as it was safe to do so, some hospitals went a step further by transitioning sicker patients to SNFs rather than keeping those patients in-house until they could safely go home. Over the last three decades, the proportion of Medicare patients leaving a hospital who were discharged to a SNF quadrupled from 5% to 20%3,4. This shifting of days from the acute to the post-acute facility setting has several negative consequences: it adds an extra transition, increases the overall time that patients spend in facilities, and increases the cost to Medicare since SNFs are reimbursed by the day whereas hospitals are paid a lump sum for the patient stay. This last point is likely part of the reason that Medicare’s spending per hospital admission on combined inpatient and post-acute facility stays increased by nearly 10% from 2004 to 20115.

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Remedy in the News

Remedy continues to be a strong advocate for the BPCI program and using bundled payment models as a path to healthcare transformation.>

CMS proposes changes to CJR: 6 key thoughts on what this means for orthopedic bundled payments
Becker's Spine Review | August 18, 2017

Is HHS’ Proposal to Scale Back Mandatory Bundled Payments a Step Back from Value-Based Care? Many Healthcare Experts Say No
Healthcare Informatics | August 18, 2017

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Chris Garcia Named CEO of Remedy Partners

Remedy Partners, the nation’s leading bundled payment company, has named Chris Garcia its chief executive officer, effective July 12, 2017. Remedy is well-positioned for accelerated growth as the healthcare industry continues to adopt bundled payments as a core value-based payment strategy.

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Bundled Payments, Palliative, Palliative Care,

Bundled Payments and the Practice of Palliative Care

Palliative care improves quality of life by relieving symptoms, providing psycho-social support, and by lowering costs by eliminating unwanted inventions, such as hospital readmissions.1,2 Because bundled payments approach episodes of care with the patient’s goals at the center of all care planning, bundled payments can help make palliative care available to patients by offering incentives that help avoid expensive care that may be at odds with the patient’s wishes. Further, effective January 2016, CMS reimburses physicians for “advance care planning” activities that support palliative care as part of the updated Physician Fee Schedule under two new CPT codes.

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Care Redesign, Total Joint Replacement, Win Whitcomb, Value Based Care, JAMA Internal Medicine, Bundled Payments, Lower Extremity Joint, TJR, Medicare

Bundled Payments are Not Associated with an Increase in Elective Procedures

Two recent studies demonstrate that the number of elective procedures does not vary significantly in bundled payment programs when compared to controls. Wilson, de Brantes and Conway analyzed1 the Medicare Bundled Payments for Care Improvement initiative to determine if the volume of Lower Joint Replacement (LJR) procedures increased under the model.  Their analysis was in response to an editorial3 in the Journal of the American Medical Association that raised questions about elective procedure volume and bundled payments in an accompanying JAMA study.2

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Bundled Payments, ACA, ACO

How ACOs and Episode Payment Models Can Work Together

ACOs and episode payment models can and do work together. To be most successful, payers need to synchronize the payment models they sponsor for participating providers. To help the Medicare program in this task, the Health Care Transformation Task Force released principles to consider when apportioning responsibility between alternative payment models covering the same patients.

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CJR, Bundled Payments, CMS, Carolyn Magill

Spotlight on Continued Success of Bundled Payments

Remedy CEO Carolyn Magill Cites Bundles as a Catalyst for Systemic Change

The spotlight was on bundled payments this week as CMS delayed the mandatory implementation of bundled payment initiatives for cardiac care and the expansion of the Comprehensive Care for Joint Replacement bundled payment pilot project. The delay, which was consistent with HHS Secretary Tom Price’s known objections to mandatory initiatives, allowed proponents of the Bundled Payment for Care Improvement initiative (BPCI) program, like Remedy Partners CEO Carolyn Magill, to reinforce the program’s success to date.

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Patient Care, Care Redesign, Win Whitcomb, Value Based Care, Care Transitions

Transitional Care Institute Hosts Webinar on Next Site of Care

The Transitional Care Institute recently hosted our first webinar of 2017, ‘High Value Care Transitions: Key Concepts in Optimizing Next Site of Care.’ In it, Chief Medical Officer Win Whitcomb and Clinical Director Susana Hall gave a comprehensive look at NSOC selection using case studies, performance data, and improvement strategies.

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Care Redesign, Bundled Payments, ACA, Politics

Secretary Price: A Strong Supporter of Voluntary Bundled Payments

When Secretary Price said "people have coverage, but they don't have care," he underscored his commitment to one of the core values of bundled payments: patient-centered care.  Dr. Price believes that “patients and doctors should be in control of healthcare”; which is why he does not support mandatory pilot programs.” He understands that providers need flexibility, not dictations, to accommodate the needs of their patients.

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Bundled Payments, Value Based Healthcare, Mandatory Bundles,, Medicare, EPM

Medicare Delays Mandatory Bundled Payments; Expansion of Voluntary Bundles Unaffected

The Medicare program delayed again its mandatory bundled payment models. This announcement, however, does not change CMS's commitment to the Bundled Payments Care Improvement (BPCI) initiative and its successor model in 2018. Specifically, CMS delayed by three months the effective dates of both the mandatory cardiac EPM programs and the expansion of the CJR model. CMS requests comment on delaying until January 2018 these effective dates.

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SNF, Post-Acute, SNF Performance Network, Bundled Payments, Care Transitions

Updated SNF Episodic Length of Stay (ELOS) Guidelines Released to Field

Managing Episodic Length of Stay (ELOS) in skilled nursing facilities (SNFs) is an important strategy to reduce unnecessary costs and improve outcomes during a patient’s episode of care. It is well established that SNF length of stay varies widely between geographic regions and by payer type (fee for service vs. managed Medicare, for example). This variability is perpetuated by a lack of accessible, standardized information about expectations, performance, and outcomes. The SNF Episodic Length of Stay (ELOS) Guidelines seek to address this issue by offering clinical recommendations and data-driven targets for managing SNF length of stay at the bundle level.

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Remedy Promotes BPCI at HHS Committee Hearing

What a whirlwind trip to D.C.!  Remedy’s Chairman Steve Wiggins and I visited the U.S. Department of Health & Human Services yesterday to share Remedy's experience in the Bundled Payment for Care Improvement initiative. We joined the CMS leaders of the BPCI initiative, who shared similar observations about the path to bundled payment success.

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BPCI, Healthcare Reform

Special Opportunity to Advocate for BPCI to HHS

As the nation focuses on the future of healthcare policy, Remedy has been advocating for the robust use of the bundled payment model as a means to improve patient outcomes and  reduce healthcare costs.

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Glossary

Anchor Stay
The period of time between the admission date and the discharge date of an episode-initiating hospital stay for a patient.


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