CMS launches bundled payment initiative

More than 500 organizations will begin participating in the Bundled Payments for Care Improvement initiative, according to the Centers for Medicare & Medicaid Services (CMS). Through this new initiative, made possible by the Patient Protection and Affordable Care Act, CMS will test how bundling payments for episodes of care can result in more coordinated care for beneficiaries and lower costs for Medicare.

“The objective of this initiative is to improve the quality of healthcare delivery for Medicare beneficiaries, while reducing program expenditures, by aligning the financial incentives of all providers,” said Acting CMS Administrator Marilyn Tavenner.

The Bundled Payments for Care Improvement initiative includes four models of bundling payments, varying by the types of healthcare providers involved and the services included in the bundle. Depending on the model type, CMS will bundle payments for services beneficiaries receive during an episode of care, encouraging hospitals, physicians, post-acute facilities and other providers as applicable to work together to improve health outcomes and lower costs. Organizations of providers participating in the initiative will agree to provide CMS a discount from expected payments for the episode of care, and then the provider partners will work together to reduce readmissions, duplicative care and complications to lower costs through improvement.

The announcement included the selection of 32 awardees in Model 1, who will begin testing bundled payments for acute care hospital stays as early as April 2013. In the coming weeks, CMS will announce a second opportunity for providers to participate in Model 1, with an anticipated start date of early 2014.  

The announcement also marked the start of Phase 1 of Models 2, 3 and 4. In Phase 1 (January-July 2013), more than100 participants partnering with more than 400 provider organizations, will receive new data from CMS on care patterns and engage in shared learning in how to improve care. Phase 1 participants are generally expected to become participants in Phase 2, in which approved participants opt to take on financial risk for episodes of care starting in July 2013, pending contract finalization and completion of CMS’ standard program integrity reviews.

See the list of awardees for Model 1 and participants for Phase 1 of Models 2, 3 and 4.