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.
CMS Embraces Innovation and Competition
Steve Wiggins with Nick Bluhm and Ryan PardoSeptember 20, 2017
Today, Seema Verma, the Centers for Medicare and Medicaid Services (CMS) Administrator, published a Request for Information seeking feedback on how to lead CMS’s Innovation Center in a new direction. Her statements reflect a belief in competition, consumer empowerment and a willingness to use waivers to enable meaningful innovation.
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
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.
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.
A significant study published in the JAMA Internal Medicine at the beginning of the year demonstrates how a health system effectively reduced episodic expenditures through bundled payments by 20 percent. Notwithstanding the rising national costs of joint replacements, Baptist Health System (BHS) saved $20 million over seven years with bundled payments.
Hospital-based specialists, generalists (e.g., hospitalists), and surgeons participating in bundled payment programs have tremendous influence over the quality and costs of patient care inside the four walls of the hospital. While many interventions also have effects after discharge, others have more limited post-acute impact. All things being equal, physicians should focus their in-hospital efforts on practices that have a positive effect on patients after they leave the hospital. For example, holding goals of care conversations, early mobilization, prompt discontinuation of urinary and central venous catheters, and asking discharge planners "Why not home?" are but a few of many practices that may improve healthcare value during the post-acute period. In the linked article, I describe how practices that represent 'thinking outside the DRG', or outside the inpatient stay, may improve patient care during recovery from a hospitalization.
The Health Care Transformation Task Force issued a strong letter to President-elect Trump, Vice President-elect Pence, and Congressional leadership supporting the continuation of public and private efforts to replace fee-for-service payments for healthcare services with value-based alternatives. Remedy Partners is one of the Task Force’s 43 member organizations (both for-profit and not-for-profit) which include six of the nation’s top 15 health systems and four of the top 25 health insurers, as well as leading national organizations representing employers, patients and their families, and the policy community.
Dr. Ezekiel Emanuel, chair of Medical Ethics & Health Policy at the University of Pennsylvania School of Medicine and the Wharton School and former Obama administration healthcare advisor, shared his thoughts on healthcare transformation and how to succeed in a bundled payment world in his keynote address at the Remedy Partners National Innovation Collaborative held in Philadelphia, November 14-15, 2016. More than 300 physicians, clinicians, and executives representing 77 organizations involved in value-based care attended the invitation-only event.
Gene Huang, Remedy Partners’ Vice President, Business Development, was a featured speaker at the 13th Annual HealthMEDX User Group in St Louis on April 12 - 14, 2016.
When you deposit your paycheck, you expect your bank to process it. If you travel out of town, you count on being able to access your money from an ATM. But patients discharged from the hospital to a rehabilitation center or nursing home may not experience such a seamless transition of their healthcare information.
The Society of Hospital Medicine recognizes 2016 as the Year of the Hospitalist, commemorating 20 years since the term hospitalist was coined and the Society of Hospital Medicine was formed. Bob Wachter and Lee Goldman sparked the latent hospitalist movement with an article titled ‘The emerging role of ‘hospitalists’ in the American Healthcare System’ in an August 1996 issue of The New England Journal of Medicine. Several weeks later, John Nelson and I, both practicing hospitalists, formed the Society of Hospital Medicine (then incorporated in 1997).
Bundled payment programs require effective care coordination encompassing the hospitalization and the post-discharge recovery period. Within this care coordination process, selecting the ‘next site of care’ after hospital discharge is a crucial element in the provision of high value patient care. Why? When looking at large data sets representing aggregate spending, the cost of post-acute care can rival that of the initial inpatient stay.(1) For many bundles, total 90-day episode spending for a patient discharged to a skilled nursing facility can be more than two times that of a patient discharged to home.(2)