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Medicare Is Simple
Monday, September 19, 2016
Delivering coordinated, high quality care for patients
September 19, 2016 By Dr. Patrick Conway,
Acting Principal Deputy Administrator and Chief Medical Officer
coordinated, high quality care for patients
In July 2016, CMS proposed new bundled payment models that
continue the Administration’s progress to shift Medicare payments from
rewarding quantity to rewarding quality by creating strong incentives for
hospitals and clinicians to deliver better care to patients at a lower cost.
These proposed new bundled payment models focus on heart attacks, heart bypass
surgery, and hip fracture surgery. They would reward hospitals that work
together with physicians and other providers to avoid complications, prevent hospital
readmissions, and speed recovery. This proposal follows the implementation of
the Comprehensive Care for Joint Replacement Model that begin earlier this
year, which introduced bundled payments for certain hip and knee replacements.
Patients want the peace of mind
that comes with knowing they will receive high quality, coordinated care from
the minute they are admitted to the hospital through their recovery. Bundling
payments for services that patients receive across a single episode of care –
such as a heart bypass surgery or hip replacement – encourages better care
coordination among hospitals, doctors, and other health care providers.
Providers participating in bundled payments must work together when patients
are in the hospital as well as after they are discharged, which should improve
their recovery and avoid preventable complications and costs by keeping people
healthy and at home.
Doctors, patient advocates, and
health care experts across the country support these models because they have
seen firsthand their potential for delivering better quality and more
cost-effective care. Public and private-sector bundled payment models have
already shown promise in improving patient outcomes while lowering costs,
including for cardiac and orthopedic care. In Medicare, more than 1,400
providers are currently participating in bundles through the Bundled Payments for Care Improvement initiative.
Early results are encouraging: orthopedic surgery bundles, in particular, have
shown promising results on cost and quality in the first two years of the
initiative. These models keep the patient at the center of care delivery and
focus on well-coordinated, high quality care.
Today, CMS is releasing the second
annual evaluation report for Models 2-4 of the Bundled Payments for Care
Improvement initiative, which include both retrospective and prospective
bundled payments that may or may not include the acute inpatient hospital stay
for a given episode of care. This report describes the characteristics of the
participants and includes quantitative results from the first year of the
initiative. Future evaluation reports will have greater ability to detect
changes in payment and quality due to larger sample sizes and the recent growth
in participation of the initiative, which generally is not reflected in this
report. Key highlights include:
11 out of the 15 clinical episode groups analyzed showed potential savings to
Medicare. Future evaluation reports will have more data to analyze individual
clinical episodes within these and additional groups;
Orthopedic surgery under Model 2 hospitals showed statistically significant
savings of $864 per episode while showing improved quality as indicated by
beneficiary surveys. Beneficiaries who received their care at
participating hospitals indicated that they had greater improvement after 90
days post-discharge in two mobility measures than beneficiaries treated at
comparison hospitals; and
Cardiovascular surgery episodes under Model 2 hospitals did not show any
savings yet but quality of care was preserved. Over the next year, we will have
significantly more data available, enabling us to better estimate effects on
costs and quality.
While there is more work to be
done, CMS continues to move forward to achieving the Administration’s goal to
have 50 percent of traditional Medicare payments tied to alternative payment
models by 2018. The 2016 goal of tying 30 percent of Medicare payments to
alternative payment models was met eleven months ahead of schedule, and we are
committed to keeping that momentum. Bundled payments – including the ongoing
Comprehensive Care for Joint Replacement Model – continue to be an integral
part of transforming our health care system by creating innovative care
delivery models that support hospitals, doctors, and other providers in their
efforts to deliver better care for patients while spending taxpayer dollars