Medicares Acute Care Episode Program 3 year demonstration program - PowerPoint PPT Presentation

May 25, 2023 •206 likes •275 views

Medicares Acute Care Episode Program 3 year demonstration program starting in 2009; 5 hospitals in 4 states Bundled payments for 37 cardiac and orthopedic procedures Up to 8% discount off normal fee-for-service payments Savings

Medicare’s Acute Care Episode Program  3 year demonstration program starting in 2009; 5 hospitals in 4 states  Bundled payments for 37 cardiac and orthopedic procedures  Up to 8% discount off normal fee-for-service payments  Savings from care coordination  Standardized care based on clinical evidence  Use patient navigators to bridge gaps  Physician report cards  peer pressure  Savings from price discounts on medical devices  Collaboration to identify quality, cost-effective devices  With greater purchasing power, hospitals could negotiate price discounts  Maintained the quality of care as measured by 22 quality measures
Using the ACA’s Key Cost Control Tool  Goal: expand a bundled payment nationwide before the President leaves office  Ensure the current health cost slowdown continues  Demonstrate the potential of the Affordable Care Act  Send a signal to health care providers  The ACE Program meets the test for expansion  Expansion could be effective for fiscal year 2015  Including post-acute care in bundling is important: over 70% of variation in Medicare costs is from variation in post-acute care
Bundled Payments vs. ACOs  ACOs are voluntary, and thus can’t be expanded nationwide  ACOs aren’t appropriate for many (rural) areas of the country  Bundled payments are easier to implement, require less upfront investment  ACOs take time to realize returns on investment  Bundled payments yield immediate price savings
Beyond bundling for acute episodes: bundling for cancer  Why cancer?  High and rising disease burden; high and rising costs of care ($173 billion by 2020)  IOM: current cancer care system is in crisis  Widely varying treatment strategies and costs, despite existing care guidelines  Drugs are a significant portion of costs  Questions to be answered:  Which cancers and stages? Bundle could vary based on specific diagnoses  What to include in the bundle? Diagnostic tests, imaging, drug administration, management fee, labs, chemotherapy, radiation services, hospitalizations, surgery  What length of time should the bundle cover?  What measures should define the bundle? Outcomes, process, patient- reported  CAP has organized a consortium of oncologists, patients, payers, and policy experts to answer these questions
Bundling need not be foreign  In 2004, Germany adopted Diagnosis Related Groups  Now Germany bundles all costs for inpatient episodes of care, including physician services  No additional payment for re-admissions related to the bundle  In 2008, Germany started bundling outpatient services  Single fixed rate for all care in a quarter of the year  Insurers offer contracts for “integrated care” – including post-acute care in the bundle  Evidence of success  Duplicative services (imaging) have declined  Use of pricey technology (imaging) has declined  More consensus on treatment pathways, less variation

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