(Post One in a series)
By Joanne Conroy, MD
CMMI launched an initiative focusing on improving care through payment innovation, improved coordination, and quality, using one price for a bundle of services. It actually makes sense: If we receive a set payment for an episode of care, would we spend those dollars differently in order to deliver better quality at a lower cost? It is like choosing to go on an all-inclusive resort vacation versus paying a la carte.
The AAMC has submitted a letter of intent with 18 academic medical centers to participate in the bundling initiative. Our role is as a facilitator/convener — we provide administrative and technical assistance. We have contracted with Manatt Health Solutions to help complete the application (more than 90 pages) and to manage the process. We are also working with Brandeis University, which will serve as custodian of the Medicare data sets we receive for each designated hospital referral region.
Representatives of all of the participating organizations met in late November. I was impressed by the intensity of everyone’s interest in figuring out what a bundle really means.
It is complicated:
— Begin by selecting a disease or procedure that will have an “anchor” hospital admission. Then, define an episode of care, including services that reflect best medical practices for that condition. Add up the payments (using historical data) for the relevant services across a population that has the same anchor admission, and average them — that is your bundled payment.
— Go through all of the CPT, MS-DRG codes (physician, hospital, and ancillary services) and determine which ones will be included and which will be excluded from the bundle.
— You will be on the hook for outliers, readmissions, hospital-acquired conditions, and so forth.
— If you bundle only the inpatient stay, any readmission that occurs within 30 days post-discharge must be covered by that bundle.
— If you include the post-acute stay in your definition of the episode, extending the bundle of services maybe 90 to 180 days after the inpatient admission, you must figure out how to align and manage all of the different providers (whom you don’t employ) while monitoring readmissions.
Participants will receive an incredible data source, the Medicare limited data set, for their entire region. You will be able to see — for the first time — the total cost of care for your patients and where that care was delivered. This is a unique opportunity to start thinking about how we manage health in a continuum rather than stopping at the hospital exit.
At the end of the November meeting, everyone was tired but still energized. The challenge in applying to be a facilitator/convener blends population management, health services analysis, financing, governance, and accountability all into one mad puzzle. More to come — stay tuned.
—Joanne Conroy, MD, is Chief Health Care Officer at the Association of American Medical Colleges. She can be reached at firstname.lastname@example.org. Follow her on Twitter @joanneconroymd.