The Bundled Payments for Care Improvement team held a webinar to update applicants on the application consideration process and the next steps they can anticipate. All Model 2, 3, and 4 applicants as well as provider partners were invited to attend. - - - CMS Innovations http://innovations.cms.gov We accept comments in the spirit of our comment policy: http://newmedia.hhs.gov/standards/comment_policy.html CMS Privacy Policy http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html

1. Bundled Payments for Care Improvement:
Application Consideration for Models 2-4
Patient Care Models Group
Innovation Center
Centers for Medicare & Medicaid Services
September 12th, 2012

2. Presenters
• Jeffrey Clough, MD, MBA, Patient Care Models Group
• Amy Harbaugh, MBA , Patient Care Models Group
• Pamela M. Pelizzari, MPH, Patient Care Models Group
• Elizabeth Truong, MHS, Patient Care Models Group
2

3. Thank you
Thank you for your continued engagement
in this initiative. We have received an
enthusiastic response from providers across
the country, and we look forward to working
with you in the coming months.
3

4. Agenda
• Timeline
• Episode convergence
• Questions
4

5. Timeline for Application Consideration
• Late September, 2012: External expert review panels
review and provide recommendations to CMS on each
application
• Early October, 2012: CMMI staff initiates group and
individual discussions with candidate awardees (derived
from panel recommendations combined with CMS
program judgment)
• Late October, 2012: CMMI staff engages in work to
address questions and issues raised by candidate
awardees
5

6. Timeline for Application Consideration
• Next steps commence: Recommended awardee vetting
and clearance of model plan by federal agencies
• Model 2,3, and 4 agreements shared and discussed with
recommended awardees
• Agreements signed; implementation begins
6

7. Episode Convergence
• Diversity of proposed episodes
• Operational need for convergence
• Informed by applications submitted and CMS
program policy objectives
• Topics will be discussed in various formats
during candidate interviews and throughout the
process
• CMMI plans for significant engagement with
candidates in the coming months
7

8. Episode Convergence
• Anchor Clinical Conditions
• Part A and Part B Exclusions
• Episode Length
8

9. Episode Convergence
• Methodology for determining the target price and
performing payment reconciliation
– Addressing outlier cases
– Approach to MS-DRGs with small numbers of episodes
– Trending target prices into performance years
• Risk-adjustment
9

10. Episode Convergence
• Beneficiary exclusion
• Proration methodology
10

11. Episode Convergence
• Discount Percentage
• Waivers
11

12. Further specific questions and issues
identified by candidate awardees
We will address these following the early October
communication with candidate awardees (applicants
who reach the next stage of consideration).
We look forward to hearing from you.
12

13. Questions?
At this time, we will accept questions via the chat
feature on your screen.
For further questions, please email BundledPayments@cms.hhs.gov
13