Category Archives: CMMI Bundling Initiative

WSJ Contributors Have It All Wrong About CMMI

By Coleen Kivlahan, MD

On April 23, 2014, an op-ed in the Wall Street Journal described the Center for Medicare and Medicaid Innovation (CMMI), one of the few bright spots on the health reform horizon in our country, as “a stealthy menace.” It was written by Lanhee Chen from the Hoover Institute (a scholar and attorney) and James Capretta from the American Enterprise Institute (a scholar and long term public policy government servant). The authors are not working in one of our nation’s health systems

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Pulling It All Together

(Post Seven in a series)

By Joanne Conroy, MD

Here we are, one week before CMMI/CMS releases the Hospital Referral Cluster data to  applicants so we can assess the “opportunities” for savings. We have had our final meeting on the definition of the episodes, and a number of our members have weighed in with detailed comments about how to define the episode of care.

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Bundling: Wrapping in Quality

(Post Six in a series)

By Joanne Conroy, MD

As our bundling group begins the journey through the currently available quality measures across inpatient and post-acute settings, the comments and revelations have been interesting:

1. There is a lot of enthusiasm for new measures that assess outcome more accurately.

However, the group is composed of realists who understand that integrating measures that are not validated or tested is foolish.

2. We realize how little we know about post-acute measures of quality, and needed education from the group members who have been living in this space. Thank you U Mass, Sinai, and Einstein!

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It’s All About Risk in Bundling Initiative

(Post Five in a series)

By Joanne Conroy, MD

One of the concerns that keep our CFOs up at night is how to minimize the financial risk of participation in our CMMI bundling initiative. There is definitely a downside risk in this project — hospitals might have to write CMS a check at the end of the year! It’s important for institutions to have “skin in the game,” so there will always be some risk. However, every CFO remembers that $2M patient who either drained the blood bank, depleted the pharmacy, or topedoed the hospital’s bottom line for the quarter. In addition to the risk associated with one catastrophic patient, there is aggregate risk to be considered: that associated with caring for a number of patients whose aggregate expenses exceed the risk tolerance of the organization.

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Building a Bundle: Setting the Baseline

(Post Four in a series)

By Joanne Conroy, MD

Last week, we launched into constructing a new bundle. We selected DRGs (Diagnosis Related Groups) 216-221, which cover valve replacement with and without complications. It makes sense because many AMCs actually do as many valves as they perform CABGs (Coronary Artery Bypass Grafts). Valve replacements can be trickier, can require postoperative anticoagulation if a mechanical valve is used, and can have a stormy postoperative course if left ventricular function has been significantly compromised prior to diagnosis.

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How Do You Construct a Bundle?

(Post Three in a series)

By Joanne Conroy, MD

We are now getting into the real grit of how you actually construct a bundle. Saying that you will name one price for an episode of care (including hospital, physician, and post-acute care for 30 to180 days post-discharge) seems simple… It is anything but!

Take a condition like pneumonia. The steps to creating a bundle include deciding what DRGs (codes that describe a bundle of services for a hospital stay) are in the bundle. For pneumonia, our working group decided to use DRGs 177 – 179 (Respiratory infections & inflammations with and without complications) and 193-195 (Simple pneumonia & pleurisy with and without complications). We did not include COPD and Asthma DRGs because the optimal management of those chronic processes was different from the acute care of pneumonia. Continue reading How Do You Construct a Bundle?

Bundling Initiative Goal: No One Loses Their Shirt!

(Post Two in a series)

By Joanne Conroy, MD

Over the past few weeks, we have been executing contracts and scheduling workgroups to determine:

  • Five disease groups that will define the specific episodes and work of care delivery redesign
  • A financial team that will struggle with gainsharing (how are profits split?), calculating the bundle and risk adjustment that should be applied if our patients are sicker or more complicated
  • A legal and governance team that will try to facilitate the integration of providers that are not employed by the AMC but are engaged in the care of the patient who has an anchor admission.

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AAMC Applies to Serve as Facilitator/Convener in CMMI Bundling Initiative

(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. Continue reading AAMC Applies to Serve as Facilitator/Convener in CMMI Bundling Initiative