CMS Releases Bundled Payment Models

On August 23, CMS’ Center for Medicare and Medicaid Innovation released a bundled payment initiative that includes four models.

  1. Gain-sharing model for acute care stays. Hospitals offer discounted DRG payments, physicians are paid fee for service (FFS) and may share in savings
  2. Inpatient stay and post acute care and related re-admissions for 30 up to 90 days post discharge for selected DRGs. This includes hospital and physician payments. Discount or "target" price bid, physicians paid FFS and aggregate savings over the target price can be shared among all participants.
  3. Post acute bundle beginning at discharge to 30 days. Like Number 2, the bundle includes physician FFS payment and related re-admissions with the same option to share savings if overall costs are less than target.
  4. Hospitals paid prospectively for an acute care stay based on bids that include physician services. Physicians would be paid out of the bundle.

ACEP suggests that its members check to see if their hospitals are going to submit proposals for any of these models. This program is a precursor to the bundled payment pilot program mandated by the Affordable Care Act, which will begin in January 2013.

CMS’ Center for Medicare and Medicaid Innovation says the intent of the initiative is to improve patient care through payment innovation that fosters improved coordination and quality through a patient-centered approach.

Read more from CMS about the bundled payment initiative and the four models.

For more information or for specific questions, please contact ACEP’s Director of Federal Affairs Barbara Tomar at 800-320-0610.

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