CMS Bundled Payments Initiative

Size: px
Start display at page:

Download "CMS Bundled Payments Initiative"

Transcription

1 October 4, 2011 Practice Groups: Health Care Health Care Reform CMS Bundled Payments Initiative By Richard P. Church and Irene B. Nsiah The Patient Protection and Affordable Care Act ( PPACA ), Pub. Law , authorized the creation within the Centers for Medicare and Medicaid Services ( CMS ) of a new Center for Medicare and Medicaid Innovation ( CMMI ) designed to test new payment models including bundled payment models. On August 23, 2011, the CMMI announced the Bundled Payments for Care Improvement Initiative ( Bundled Payment Initiative or the Initiative ). The Bundled Payment Initiative proposal includes four different payment models for providers: three retrospective payment bundling models and one prospective payment bundling model, each centered on a single episode of care or so-called episode anchor. The Initiative comes in follow up to CMS s proposed Accountable Care Organization ( ACO ) rule released in April 2011, 1 which has been widely criticized as impracticable in its proposed form. Since releasing the proposed ACO rule, CMS has promulgated a number of new demonstration projects, such as the Pioneer ACO, Advanced Payment ACO, and now the Bundled Payment Initiative, each of which appears designed to address some of the flaws identified in the proposed ACO rule. The Bundled Payment Initiative provides greater flexibility to the provider in determining target payment amounts, the episodes of care for which the provider will be accountable (and in turn for which beneficiaries it will be responsible), and the services to include in the bundled payment. The Four Models As set forth in detail in the CMS Table reprinted below, under the Bundled Payment Initiative, CMS will pay a single amount for an episode of care involving a defined period and set of services: Model 1: covers all Part A services (including inpatient DRG, diagnostic services, and other separately billable Part A services) provided by a hospital in the 3 days prior to admission through acute discharge. Model 2: covers the acute care stay, physician services, and other post-acute services (i.e. all Part A and Part B services, including readmissions) related to the episode of care for a period beginning with the acute inpatient stay and extending for a minimum of 30 days with a preference for longer post-acute care periods of 90 days or greater. Model 3: covers all post-acute care services (i.e. all Part A and Part B services, including readmissions) related to the episode of care for a period beginning with a skilled nursing facility stay, inpatient rehabilitation or long-term care hospital stay, or the initiation of home health services and extending for a minimum of 30 days with a preference for longer post-acute care periods. Model 4: covers all Part A services (including inpatient DRG, diagnostic services, and other separately billable Part A services) provided by a hospital in the 3 days prior to admission through acute discharge as well as any related Part A hospital expenses regarding a readmission and all Part B professional services during the same periods; payment is made to the hospital prospectively, i.e. 1 Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations, 76 Fed. Reg (April 7, 2011).

2 this is akin to a super DRG that includes all hospital and physician services and requires physician providers to bill the hospital for services rendered. The Initiative requires applicants in each model to provide CMS with a discount from the amount that CMS would otherwise pay for patient care under the traditional fee-for-service payment structure. CMS allows applicants to set the amount of the discount, but has stated that it will give preference to applicants that offer higher discounts. Under Model 1, in exchange for this discount, a hospital is permitted to make certain gainsharing payments to physicians, as discussed in more detail below. Under Models 2 through 4, the awardee will also share savings and bear risk for achieving an overall target price for the episode of care. CMS will pay using the current fee-for-service system. At the end of a patient s episode of care, CMS will compare the total FFS payments with the target price. If the total fee-for-service payments are below the target price, the participating organization may share in the savings. On the other hand, if total payments exceed the target price, the participating organization must pay back the difference to CMS. Under Model 4, CMS pays the participating organization a single prospective bundled payment for the episode of care. The organization must then distribute the payments to participating providers on a fee-for-service basis. KEY FEATURES OF BUNDLED PAYMENT MODELS COMPARED Model / Feature MODEL 1 Inpatient Stay Only MODEL 2 Inpatient Stay plus Postdischarge Services MODEL 3 Post-discharge Services Only MODEL 4 Inpatient Stay Only Eligible Awardees Acute care hospitals paid under the IPPS Physician-hospital participating health care providers Acute care hospitals paid under the IPPS Physician-hospital Post-acute providers participating health care providers Acute care hospitals paid under the IPPS Long-term care hospitals Inpatient rehabilitation facilities Skilled nursing facilities Home health agency Physician-hospital participating health care providers Acute care hospitals paid under the IPPS Physicianhospital participating health care providers 2

3 Model / Feature MODEL 1 Inpatient Stay Only MODEL 2 Inpatient Stay plus Postdischarge Services MODEL 3 Post-discharge Services Only MODEL 4 Inpatient Stay Only Payment of Bundle and Target Price Discounted IPPS payment; no separate target price Retrospective comparison of target price and actual FFS payments Retrospective comparison of target price and actual FFS payments Prospectively set payment Clinical Conditions Targeted All MS-DRGs Applicants to propose based on MS-DRG for inpatient hospital stay Applicants to propose based on MS-DRG for inpatient hospital stay Applicants to propose based on MS-DRG for inpatient hospital stay Types of Services Included in Bundle Inpatient hospital services Inpatient hospital and physician services Related post-acute care services Related readmissions Other services defined in the bundle Post-acute care services Related readmissions Other services defined in the bundle Inpatient hospital and physician services Related readmissions Expected Discount Provided to Medicare applicant; CMS requires minimum discounts increasing from 0% in first 6 mos. to 2% in Year 3 applicant; CMS requires minimum discount of 3% for days postdischarge episode; 2% for 90 days or longer episode applicant applicant; subject to minimum discount of 3%; larger discount for MS-DRGs in ACE Demonstration Payment from CMS to Providers Quality Measures Acute care hospital: IPPS payment less pre-determined discount Physician: Traditional fee schedule payment (not included in episode or subject to discount) All Hospital IQR measures and additional measures to be proposed by applicants Traditional fee-forservice payment to all providers and suppliers, subject to reconciliation with predetermined target price Traditional fee-forservice payment to all providers and suppliers, subject to reconciliation with predetermined target price Prospectively established bundled payment to admitting hospital; hospitals distribute payments from bundled payment applicants, but CMS will ultimately establish a standardized set of measures that will be aligned to the greatest extent possible with measures in other CMS programs *Source: CMS Fact Sheet, Bundled Payments for Care Improvement Initiative, Appendix (August 23, 2011) 3

4 Eligible Entities The Bundled Payment Initiative allows a variety of health care providers to participate in at least one of the four models. Depending on which of the four models an organization chooses, the following providers may participate in the Bundled Payment Initiative: Physician group Acute care hospitals Post-acute care providers Health systems Skilled nursing facilities Home health agencies Long-term care hospitals Inpatient rehabilitation facilities Physician hospital Conveners of participating health care providers The request for application ( RFA ) defines a convener as an entity that can bring together multiple participating health care providers, such as a state hospital association or collaboration of providers. Under the Bundled Payment Initiative, a convener may apply to participate as an awardee or facilitator. To participate as an awardee, the convener must bear financial responsibility for the providers that it has brought together. A convener that is not capable of bearing financial risk may apply to be a facilitator. As a facilitator, the convener provides administrative and technical support to the Initiative. In addition, a facilitator convener can share risk and cost-savings with participating. Similar to the proposed ACO rule, CMS indicates that all participating awardees must: Develop quality measures, internal monitoring mechanisms, and quality improvement protocols to insure patient care is not reduced to achieve cost savings. As an example, participants under Model 1 must report the full set of Hospital Inpatient Quality Reporting Program (Hospital IQR) measures. Must not restrict beneficiary choice of provider/supplier. Must notify beneficiaries the provider is participating in the Bundled Payment Initiative. Among numerous standards that CMS indicates it will review in regard to proposed applications to participate in the Bundled Payment Initiative, CMS indicates that it will give preference to applicants that: Are meaningful users of health information technology or have a minimum of 50% of their providers meeting the standards for meaningful use. Indicate a higher historical rate of physician participation in the Physician Quality Reporting System ( PQRS ) and describe ways to encourage greater physician participation in PQRS for the duration of the Initiative. Include governing bodies with meaningful representation from consumer advocates, patients, and all participating provider types/. Demonstrate other partnerships with state Medicaid programs, private payors, or multi-payor collaborations to redesign care. 4

5 Regulatory Parameters Under PPACA, CMS is authorized in conjunction with CMMI projects to provide waivers to key health care regulatory parameters, such as the federal physician self-referral law, 2 the federal antikickback statute 3 and the Civil Monetary Penalties provisions related to gainsharing. 4 To what extent CMS intends to utilize that authority similar to what was provided in regard to waivers to the proposed ACO rule 5 is unclear. The RFA requests providers and suppliers to identify what waivers are requested as to fraud and abuse provisions. Further, the Initiative specifically contemplates waivers of the gainsharing rule similar to those found in other CMS demonstration projects and CMS identifies minimum parameters for the gainsharing component of proposals, including: Physician and nonphysician practitioners may not reduce or limit services that are medically necessary to a patient entitled to benefits under Medicare. Gainsharing arrangements must be transparent and auditable. Physician participation in the gainsharing aspect must be voluntary; however, physicians may be required to be paid through the bundled payment model for all patients admitted for included DRGs. Overall quality of care for beneficiaries cared for by physicians and nonphysician practitioners participating in gainsharing must meet minimum quality requirements and then remain constant or improve for the duration of the arrangement. Individual physicians and nonphysician practitioners must meet quality thresholds and engage in quality improvement. Payments may not be based on the volume or value of referrals or business otherwise generated between hospital and physician. Payments to physicians and nonphysician practitioners may not exceed 50% of the amount that is normally paid to physicians and nonphysician practitioners for the cases included in the gainsharing initiative. Clinical integration models may also implicate federal and state antitrust and tax-exempt entity standards, however, and the RFA is silent on whether CMS will work with the Federal Trade Commission, Department of Justice, and Internal Revenue Service to obtain similar guidance to that promulgated in conjunction with the ACO rule as to this program. 6 Further, such arrangements should also be reviewed carefully under state insurance laws (as to risk-bearing models) and corporate practice of medicine guidance. Timeline Organizations interested in Model 1 must submit a nonbinding letter of intent ( LOI ) by October 6, 2011, and the application by November 18, For Models 2 through 4, interested 2 42 U.S.C. 1395nn U.S.C. 1320a-7b(b) U.S.C. 1320a-7a(b) (prohibits a hospital from making a payment, directly or indirectly, to induce a physician to reduce or limit services to Medicare and Medicaid beneficiaries under the physician s direct care). 5 Medicare Program; Waiver Designs in Connection With the Medicare Shared Savings Program and the Innovation Center, 76 Fed. Reg (April 7, 2011). 6 Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program, 76 Fed. Reg (April 19, 2011); Internal Revenue Service, Notice (March 31, 2011). 5

6 must submit a nonbinding LOI by November 4, 2011 and the application by March 15, Organizations interested in receiving historical Medicare claims data in preparation for Models 2 through 4 must file a separate research packet and data-use agreement in conjunction with the LOI. CMS will not consider applications from that do not submit an LOI. The anticipated start date for Model 1 awardees is the first quarter of 2012, with a performance period of 3 years, and the possibility of extending an additional 2 years. CMS has not indicated the anticipated start date for Models 2 through 4. Conclusion The Bundled Payment Initiative may provide a valuable alternative to health care providers interested in integrated delivery and payment models without incurring the organizational complexities and expense associated with development of an ACO. The Bundled Payment Initiative has certain key advantages over ACOs, such as: Not requiring the establishment of new legal structures. Allowing a provider to know in advance which beneficiaries and periods of care for which it will be accountable. Limiting the amount of risk-bearing a provider will be involved in (and similarly the development of protocols and processes to effectively manage costs) by focusing only on key DRGs for which the provider will participate. With this said, the Bundled Payment Initiative still involves significant complexity. Depending on the level of flexibility offered by CMS in regard to regulatory waivers, current information technology infrastructure, the need to develop integrated care protocols, and the complexities associated with administering the program (e.g. under Model 4 - becoming a payor), providers may still face substantial costs in effectively participating in the Bundled Payment Initiative that should be reviewed carefully. Further, entities participation in Models 2 through 4 must be capable of achieving savings and prepared to bear substantial down-side risk if failing to do so. Nonetheless, given that LOIs are nonbinding and CMS indicates subsequent applications can be withdrawn, providers may want to file LOIs now to insure their ability to participate, while assessing the value and costs of doing so under the RFA. Contacts: Boston Jan E. Murray jan.murray@klgates.com Miami William J. Spratt william.spratt@klgates.com Chicago Daniel J. Lawler daniel.lawler@klgates.com Newark Stephen A. Timoni stephen.timoni@klgates.com Harrisburg Ruth E. Granfors ruth.granfors@klgates.com Pittsburgh Edward V. Weisgerber ed.weisgerber@klgates.com 6

7 Research Triangle Park Mary Beth Johnston Washington, D.C. Stephen H. Cooper Richard P. Church

Comparison of Bundled Payment Models. Model 1 Model 2 Model 3 Model 4. hospitals, physicians, and post-acute care where

Comparison of Bundled Payment Models. Model 1 Model 2 Model 3 Model 4. hospitals, physicians, and post-acute care where Comparison of Bundled Payment Models General Description Eligible awardees Retrospective bundled Retrospective bundled payment models for payment models for hospitals, physicians, and post-acute care where

More information

Questions and Answers on the CMS Comprehensive Care for Joint Replacement Model

Questions and Answers on the CMS Comprehensive Care for Joint Replacement Model Questions and Answers on the CMS Comprehensive Care for Joint Replacement Model MEGGAN BUSHEE, ESQ. 704.343.2360 mbushee@mcguirewoods.com 201 North Tryon Street, Suite 3000 Charlotte, North Carolina 28202-2146

More information

The Center for Medicare & Medicaid Innovations: Programs & Initiatives

The Center for Medicare & Medicaid Innovations: Programs & Initiatives The Center for Medicare & Medicaid Innovations: Programs & Initiatives Rob Stone, Esq. American Health Lawyers Association Institute on Medicare & Medicaid Payment Issues March 30-April 1, 2012 CMMI Mission

More information

3/16/2016. Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider. AKS designed to prevent improper referrals, which can lead to:

3/16/2016. Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider. AKS designed to prevent improper referrals, which can lead to: Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider Alan Schabes, Partner Benesch, Friedlander, Coplan & Aronoff LLP Shannon Drake, VP, Associate General Counsel Kindred at Home Amanda

More information

The Accountable Care Organization & Compliance

The Accountable Care Organization & Compliance The Accountable Care Organization & Compliance Joy A. Heim, Compliance Officer Franciscan ACO, Inc. HCCA Regional Conference Indianapolis, Indiana September 30, 2016 1 Creation of Medicare Accountable

More information

The Accountable Care Organization & Compliance

The Accountable Care Organization & Compliance The Accountable Care Organization & Compliance Joy A. Heim, Compliance Officer Franciscan ACO, Inc. HCCA Regional Conference Indianapolis, Indiana September 30, 2016 1 Creation of Medicare Accountable

More information

4/9/2016. The changing health care market THE CHANGING HEALTH CARE MARKET. CPAs & ADVISORS

4/9/2016. The changing health care market THE CHANGING HEALTH CARE MARKET. CPAs & ADVISORS CPAs & ADVISORS experience support // ADVANCED PAYMENT MODELS: CJR Eric. M. Rogers MEd. RT(R) Managing Consultant The changing health care market THE CHANGING HEALTH CARE MARKET HHS goal of 30% of traditional

More information

Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider

Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider Alan Schabes, Partner Benesch, Friedlander, Coplan & Aronoff LLP Shannon Drake, VP, Associate General Counsel Kindred at Home Amanda

More information

MEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care 8/12/2015.

MEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care 8/12/2015. MEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care August 13, 2015 Eric M. Rogers MEd RT(R) Managing Consultant erogers@bkd.com Jeff Bond President

More information

Accountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE

Accountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE Accountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE The information in this document summarizes a proposed rule issued by the Centers for Medicare and Medicaid id Services.

More information

Furthering the agency s stated intention to pay for value over volume,

Furthering the agency s stated intention to pay for value over volume, in the news Health Care September 2016 The Future Is Now: CMS Proposes Broad Bundled Payment Expansion for Cardiac Care Episodes In this Issue: Episode Payment Models... 2 Cardiac Rehabilitation Incentives...

More information

Health Care Alert. Health Care Reform Client Alert Series

Health Care Alert. Health Care Reform Client Alert Series August 2010 Authors: Paul W. Shaw paul.shaw@klgates.com +1.617.261.3111 Stephanie D. Wall stephanie.wall@klgates.com +1.412.355.8364 K&L Gates includes lawyers practicing out of 36 offices located in North

More information

December 3, 2010 BY COURIER AND ELECTRONIC MAIL

December 3, 2010 BY COURIER AND ELECTRONIC MAIL Charles N. Kahn III President & CEO December 3, 2010 BY COURIER AND ELECTRONIC MAIL Donald Berwick, M.D. Administrator Centers for Medicare & Medicaid Services Attention: CMS-6028-P Hubert H. Humphrey

More information

Request for Information Regarding Accountable Care Organizations (ACOs) and Medicare Shared Savings Programs (CMS-1345-NC)

Request for Information Regarding Accountable Care Organizations (ACOs) and Medicare Shared Savings Programs (CMS-1345-NC) Via Electronic Submission Donald Berwick, MD, MPP Administrator Centers for Medicare & Medicaid Services ATTN: CMS-1345-NC 7500 Security Blvd. Baltimore, MD 21244-8013 Re: Request for Information Regarding

More information

Accountable Care and Governance Challenges Under the Affordable Care Act

Accountable Care and Governance Challenges Under the Affordable Care Act Accountable Care and Governance Challenges Under the Affordable Care Act The First National Congress on Healthcare Clinical Innovations, Quality Improvement and Cost Containment October 26, 2011 Doug Hastings

More information

Advancing Care Coordination Proposed Rule

Advancing Care Coordination Proposed Rule Advancing Care Coordination Proposed Rule Released July 25, 2016 Erin Smith, JD VP and Executive Director, PACCR Jourdan Meltzer Research Associate, PACCR August 4, 2016 1 Presentation Overview Three new

More information

agenda Speaker Introductions Audience Poll Understanding Bundled Payments Importance of Physician Alignment Best Practices for Physician Engagement

agenda Speaker Introductions Audience Poll Understanding Bundled Payments Importance of Physician Alignment Best Practices for Physician Engagement agenda Speaker Introductions Audience Poll Understanding Bundled Payments Importance of Physician Alignment Best Practices for Physician Engagement Q&A meet our speakers Susan Boydell Partner Barlow/McCarthy

More information

HOSPITALS & HEALTH SYSTEMS: DATA-DRIVEN STRATEGY FOR BUNDLED PAYMENT SUCCESS 4/19/2016. April 20, 2016

HOSPITALS & HEALTH SYSTEMS: DATA-DRIVEN STRATEGY FOR BUNDLED PAYMENT SUCCESS 4/19/2016. April 20, 2016 HOSPITALS & HEALTH SYSTEMS: DATA-DRIVEN STRATEGY FOR BUNDLED PAYMENT SUCCESS April 20, 2016 Eddie Marmouget National Industry Partner emarmouget@bkd.com Eric Rogers Managing Consultant erogers@bkd.com

More information

Summary and Analysis of CMS Proposed and Final Rules versus AAOS Comments: Comprehensive Care for Joint Replacement Model (CJR)

Summary and Analysis of CMS Proposed and Final Rules versus AAOS Comments: Comprehensive Care for Joint Replacement Model (CJR) Summary and Analysis of CMS Proposed and Final Rules versus AAOS Comments: Comprehensive Care for Joint Replacement Model (CJR) The table below summarizes the specific provisions noted in the Medicare

More information

PASSPORT ecare NEXT AND THE AFFORDABLE CARE ACT

PASSPORT ecare NEXT AND THE AFFORDABLE CARE ACT REVENUE CYCLE INSIGHTS PATIENT ACCESS PASSPORT ecare NEXT AND THE AFFORDABLE CARE ACT Maximizing Reimbursements For Acute Care Hospitals Executive Summary The Affordable Care Act (ACA) authorizes several

More information

The Pain or the Gain?

The Pain or the Gain? The Pain or the Gain? Comprehensive Care Joint Replacement (CJR) Model DRG 469 (Major joint replacement with major complications) DRG 470 (Major joint without major complications or comorbidities) Actual

More information

Data-Driven Strategy for New Payment Models. Objectives. Common Acronyms

Data-Driven Strategy for New Payment Models. Objectives. Common Acronyms Data-Driven Strategy for New Payment Models Mark Sharp, CPA Partner msharp@bkd.com Objectives Understand new payment model reforms and bundling arrangements Learn how these new payment models can impact

More information

Payment and Delivery System Reform in Vermont: 2016 and Beyond

Payment and Delivery System Reform in Vermont: 2016 and Beyond Payment and Delivery System Reform in Vermont: 2016 and Beyond Richard Slusky, Director of Reform Green Mountain Care Board Presentation to GMCB August 13, 2015 Transition Year 2016 1. Medicare Waiver

More information

Alternative Payment Models and Health IT

Alternative Payment Models and Health IT Alternative Payment Models and Health IT Health DataPalooza Preconference May 8, 2016 Kelly Cronin, MS, MPH, Director, Office of Care Transformation, ONC/HHS HHS Goals for Medicare Payment Reform In January

More information

February 9, 2012 Orlando, Florida

February 9, 2012 Orlando, Florida American Health Lawyers Association Physician and Physician Organizations Law Institute Regulatory & Payment Issues and the Patient Centered Medical Home February 9, 2012 Orlando, Florida John E. Wyand,

More information

Compliance Issues For Multi-Provider Collaborations: How To Spot & Avoid Potential Pitfalls

Compliance Issues For Multi-Provider Collaborations: How To Spot & Avoid Potential Pitfalls Compliance Issues For Multi-Provider Collaborations: How To Spot & Avoid Potential Pitfalls LeadingAge New York s Financial Managers Annual Conference Wednesday, August 31, 2016 Saratoga Hilton, Saratoga

More information

PHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq.

PHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq. PHCA Webinar January 30, 2014 Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq. 1 2 Intended to: Encourage the development of ACOs in Medicare Promotes accountability for a patient population and coordinates

More information

Technical Overview of HCIP/CCIP

Technical Overview of HCIP/CCIP Technical Overview of HCIP/CCIP Using Care Redesign to Align Provider Incentives Presentation to HFMA, Maryland Chapter HSCRC Care Redesign Summit August 18, 2017 Facilitators Nicole Stallings Vice President,

More information

Assignment of Medicare Fee-for-Service Beneficiaries

Assignment of Medicare Fee-for-Service Beneficiaries February 6, 2015 Ms. Marilyn B. Tavenner, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1461-P Room 445-G, Hubert H. Humphrey Building 200

More information

HEALTH CARE REFORM IN THE U.S.

HEALTH CARE REFORM IN THE U.S. HEALTH CARE REFORM IN THE U.S. A LOOK AT THE PAST, PRESENT AND FUTURE Carolyn Belk January 11, 2016 0 HEALTH CARE REFORM BIRTH OF THE AFFORDABLE CARE ACT Health care reform in the U.S. has been an ongoing

More information

08/07/2015. Next Generation ACO Model. What is an ACO? Preliminary Beneficiary Engagement Timeline

08/07/2015. Next Generation ACO Model. What is an ACO? Preliminary Beneficiary Engagement Timeline Next Generation ACO Model National Training Program RO V and RO VII St. Louis August 10-11, 2015 What is an ACO? Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health

More information

CPAs & ADVISORS. experience support // ADVANCED PAYMENT MODELS: CJR

CPAs & ADVISORS. experience support // ADVANCED PAYMENT MODELS: CJR CPAs & ADVISORS experience support // ADVANCED PAYMENT MODELS: CJR Andy M. Williams Partner BKD Eric M. Rogers Managing Consultant BKD Will McLeod VP of Patient Services McLeod Health Emily Adams Associate

More information

Bundled Payments to Align Providers and Increase Value to Patients

Bundled Payments to Align Providers and Increase Value to Patients Bundled Payments to Align Providers and Increase Value to Patients Stephanie Calcasola, MSN, RN-BC Director of Quality and Medical Management Baystate Health Baystate Medical Center Baystate Health Is

More information

Healthcare Leadership Council: John Perticone Golden Living 3/9/2016

Healthcare Leadership Council: John Perticone Golden Living 3/9/2016 Healthcare Leadership Council: Care Transitions in Post Acute Care John Perticone Golden Living 3/9/2016 Golden Living Profile Golden Living Centers and Communities 296 skilled nursing facilities 15 assisted

More information

The Accountable Care Organization Specific Objectives

The Accountable Care Organization Specific Objectives Accountable Care Organizations and You E. Christopher h Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State

More information

The New World of Value Driven Cardiac Care

The New World of Value Driven Cardiac Care 1 The New World of Value Driven Cardiac Care Disclosures MPA Healthcare Solutions is an analytic health care consultancy that provides clients with insight into clinical performance; aids them in the evaluation,

More information

Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013)

Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) 24 percent (52 ACOs) earned shared savings bonus 27 percent (60 ACOs) reduced spending,

More information

Bundled Payments. AMGA September 25, 2013 AGENDA. Who Are We. Our Business Challenge. Episode Process. Experience

Bundled Payments. AMGA September 25, 2013 AGENDA. Who Are We. Our Business Challenge. Episode Process. Experience Bundled Payments AMGA September 25, 2013 Who Are We AGENDA Our Business Challenge Episode Process Experience 1 Cleveland Clinic is transforming Fee for service Fee for value 3 Fast Facts 41,200 employees

More information

Physician Compensation in an Era of New Reimbursement Models

Physician Compensation in an Era of New Reimbursement Models 2014 IHA Annual Membership Meeting Physician Compensation in an Era of New Reimbursement Models Taryn E. Stone Ice Miller LLP (317) 236-5872 taryn.stone@ Agenda Background New Reimbursement Models Trends

More information

Redesigning Post-Acute Care: Value Based Payment Models

Redesigning Post-Acute Care: Value Based Payment Models Redesigning Post-Acute Care: Value Based Payment Models Liz Almeida-Sanborn, MS, PT President Preferred Therapy Solutions This session will address: Discussion of the emergence of voluntary and mandatory

More information

REPORT OF THE BOARD OF TRUSTEES

REPORT OF THE BOARD OF TRUSTEES REPORT OF THE BOARD OF TRUSTEES B of T Report 21-A-17 Subject: Presented by: Risk Adjustment Refinement in Accountable Care Organization (ACO) Settings and Medicare Shared Savings Programs (MSSP) Patrice

More information

Centers for Medicare & Medicaid Services: Innovation Center New Direction

Centers for Medicare & Medicaid Services: Innovation Center New Direction Centers for Medicare & Medicaid Services: Innovation Center New Direction I. Background One of the most important goals at CMS is fostering an affordable, accessible healthcare system that puts patients

More information

The Intersection of Compliance and Quality Health Care Compliance Association North Central Regional Annual Conference

The Intersection of Compliance and Quality Health Care Compliance Association North Central Regional Annual Conference The Intersection of Compliance and Quality Health Care Compliance Association North Central Regional Annual Conference October 1, 2010 Mark J. Swearingen, Esq. Hall, Render, Killian, Heath & Lyman One

More information

Diane Meyer, CHC (650) Agenda

Diane Meyer, CHC (650) Agenda The Road Ahead and How to Navigate It Kevin D. Lyles, Esq. kdlyles@jonesday.com (614) 281-3821 Diane Meyer, CHC DMeyer@stanfordmed.org (650) 724-2572 Frank E. Sheeder, Esq. fesheeder@jonesday.com (214)

More information

Episode Payment Models Final Rule & Analysis

Episode Payment Models Final Rule & Analysis Episode Payment Models Final Rule & Analysis February 15, 2017 Agenda Overview Changes from Proposed Rule Categorization of Episodes Episode Attribution Reconciliation Quality Performance Cardiac Rehab

More information

The Cost of Care: Understanding the Next Generation of Payment Models

The Cost of Care: Understanding the Next Generation of Payment Models The Cost of Care: Understanding the Next Generation of Payment Models Presented by: Debbie Welle Powell, MPA, Vice President Sisters of Charity Health System and Exempla Healthcare September 27 th, 2012

More information

Medicare, Managed Care & Emerging Trends

Medicare, Managed Care & Emerging Trends Medicare, Managed Care & Emerging Trends LeadingAge Michigan 2015 Annual Leadership Institute August 12, 2015 Jon Lanczak, Manager Beth Sullivan, Senior Manager Plante Moran, PLLC Overall Theme Healthcare

More information

PREPARING FOR RISK-BASED OUTCOMES OF BUNDLED CARE

PREPARING FOR RISK-BASED OUTCOMES OF BUNDLED CARE CPAs & ADVISORS experience support // PREPARING FOR RISK-BASED OUTCOMES OF BUNDLED CARE Jackie Nussbaum MHA, CPC, CHFP, FHFMA Director Eric Rogers M.Ed. RT Managing Consultant THE CHANGING HEALTH CARE

More information

RE: Request for Information: Centers for Medicare & Medicaid Services, Direct Provider Contracting Models

RE: Request for Information: Centers for Medicare & Medicaid Services, Direct Provider Contracting Models Seema Verma Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W., Room 445-G Washington, DC 20201 RE: Request for Information: Centers for Medicare

More information

Making CJR Work for You. A Roadmap for Successful Implementation of Medicare Bundles

Making CJR Work for You. A Roadmap for Successful Implementation of Medicare Bundles December 10, 2015 Making CJR Work for You A Roadmap for Successful Implementation of Medicare Bundles https://innovation.cms.gov/initiatives/cjr Sheldon Hamburger shamburger@thearistonegroup.com (248)

More information

I. Disclosure Requirements for Financial Relationships Between Hospitals and Physicians

I. Disclosure Requirements for Financial Relationships Between Hospitals and Physicians 2400:1018 BNA s HEALTH LAW & BUSINESS SERIES provided certain additional elements (based largely on the physician recruitment exception) are satisfied. 133 10. Professional courtesy, 42 C.F.R. 411.357(s)

More information

Health Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10

Health Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10 Health Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10 On March 23, 2010, President Obama signed a comprehensive health care reform bill (H.R. 3590) into law. On March

More information

Quality, Cost and Business Intelligence in Healthcare

Quality, Cost and Business Intelligence in Healthcare Quality, Cost and Business Intelligence in Healthcare Maitri Vaidya Population Health Executive DBA, MHA, CPHQ May 2016 Where are we going? IHI Triple Aim Improve the patient experience of care Lower

More information

Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS

Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS CMS support of Health Care Delivery System Reform (DSR) will result in better care, smarter spending, and healthier

More information

Health Care Alert. Proposed Rules Seek to Offer Hospitals Clarity and Flexibility. Physician Supervision of Outpatient Services.

Health Care Alert. Proposed Rules Seek to Offer Hospitals Clarity and Flexibility. Physician Supervision of Outpatient Services. July 23, 2009 Authors: Mary Beth F. Johnston marybeth.johnston@klgates.com +1.919.466.1181 Kelly D. Furr kelly.furr@klgates.com +1.919.466.1240 Katharine L. Schaeffer kathy.schaeffer@klgates.com +1.919.466.1114

More information

2013 Health Care Regulatory Update. January 8, 2013

2013 Health Care Regulatory Update. January 8, 2013 2013 Health Care Regulatory Update January 8, 2013 Quality-Based Payment Reform, ACOs and Clinical Integration Bruce Johnson and Tom Donohoe Overview Quality-based payment reform programs Major programs

More information

Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers

Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers Presented to the Wisconsin Association for Home Health Care November 3, 2017 By: Laura Rose WHA Vice President, Policy Development

More information

Value-Based Care Contracting and Legal Issues

Value-Based Care Contracting and Legal Issues Session 4b Value-Based Care Contracting and Legal Issues Presented by: Janet Walker Farrer General Counsel and Insurance Legal Department Chair Ascension Health Leah Stewart Associate Vice President for

More information

CJR Final Rule: Policy Changes and Strategies for Bundled Payment Success

CJR Final Rule: Policy Changes and Strategies for Bundled Payment Success CJR Final Rule: Policy Changes and Strategies for Bundled Payment Success Melinda Hancock, Edward Stall, Craig Tolbert, Michael Wolford Friday, November 20, 2015 1 Agenda 1) Overview of CJR Model 2) Policy

More information

Course Module Objectives

Course Module Objectives Course Module Objectives CM100-18: Scope of Services, Practice, and Education CM200-18: The Professional Case Manager Case Management History, Regulations and Practice Settings Case Management Scope of

More information

April 26, Ms. Seema Verma, MPH Administrator Centers for Medicare & Medicaid Services. Dear Secretary Price and Administrator Verma:

April 26, Ms. Seema Verma, MPH Administrator Centers for Medicare & Medicaid Services. Dear Secretary Price and Administrator Verma: April 26, 2017 Thomas E. Price, MD Secretary Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, DC 20201 Ms. Seema Verma, MPH Administrator Centers

More information

Medicare Physician Payment Reform:

Medicare Physician Payment Reform: Medicare Physician Payment Reform: Implications and Options for Physicians and Hospitals Background The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 14, 2015.

More information

Accountable Care Organizations. What the Nurse Executive Needs to Know. Rebecca F. Cady, Esq., RNC, BSN, JD, CPHRM

Accountable Care Organizations. What the Nurse Executive Needs to Know. Rebecca F. Cady, Esq., RNC, BSN, JD, CPHRM JONA S Healthcare Law, Ethics, and Regulation / Volume 13, Number 2 / Copyright B 2011 Wolters Kluwer Health Lippincott Williams & Wilkins Accountable Care Organizations What the Nurse Executive Needs

More information

The President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform. Summary

The President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform. Summary Current Law The President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform Summary Home Health Agencies Under current law, beneficiaries who are generally restricted to

More information

The Reality of Health Care Reform: Accountable Care, Bundled Payments and Opportunities for Innovation

The Reality of Health Care Reform: Accountable Care, Bundled Payments and Opportunities for Innovation The Reality of Health Care Reform: Accountable Care, Bundled Payments and Opportunities for Innovation May 11, 2010 Douglas A. Hastings Chair, Epstein Becker & Green, P.C. Member, Board on Health Care

More information

Practice Implications for Accountable Care Organizations

Practice Implications for Accountable Care Organizations Practice Implications for Accountable Care Organizations An Overview following the Final Rule Gregory M. Marsh, MPH, PMP December 14, 2011 Why CCME? Effective EHR/HIE Implementation will: Improve patient

More information

Physician Only ACOs: An Opportunity to Consider * Elias N. Matsakis, Esq.

Physician Only ACOs: An Opportunity to Consider * Elias N. Matsakis, Esq. Physician Only ACOs: An Opportunity to Consider * Elias N. Matsakis, Esq. The Affordable Care Act authorized the Center for Medicare and Medicaid Services (CMS) to establish the Medicare Shared Savings

More information

MEMORANDUM. TO: Infectious Diseases Society of America FROM: King & Spalding

MEMORANDUM. TO: Infectious Diseases Society of America FROM: King & Spalding King & Spalding LLP 1700 Pennsylvania Ave, NW Suite 200 Washington, D.C. 20006-4707 Tel: +1 202 737 0500 Fax: +1 202 626 3737 www.kslaw.com MEMORANDUM TO: Infectious Diseases Society of America FROM: King

More information

Payment of hospital inpatient services. (A) HPP.

Payment of hospital inpatient services. (A) HPP. ACTION: Final DATE: 01/22/2018 8:09 AM 4123-6-37.1 Payment of hospital inpatient services. (A) HPP. Unless an MCO has negotiated a different payment rate with a hospital pursuant to rule 4123-6-10 of the

More information

The Challenges and Opportunities in Using Data Bundled Payment, Care Improvement

The Challenges and Opportunities in Using Data Bundled Payment, Care Improvement The Challenges and Opportunities in Using Data Bundled Payment, Care Improvement Helen Macfie, Pharm.D., FABC For IHI Leading Population Heath Transformation February, 2017 It started with a project PHYSICIAN

More information

Expanded Scope of Practice in the Pharmacy Setting: Current Trends and Future State for Pharmacists and Pharmacy Technicians

Expanded Scope of Practice in the Pharmacy Setting: Current Trends and Future State for Pharmacists and Pharmacy Technicians Expanded Scope of Practice in the Pharmacy Setting: Current Trends and Future State for Pharmacists and Pharmacy Technicians Todd A. Nova Partner Hall Render tnova@hallrender.com 414-721-0464 Target Audience:

More information

MACRA for Critical Access Hospitals. Tuesday, July 26, 2016 Webinar

MACRA for Critical Access Hospitals. Tuesday, July 26, 2016 Webinar MACRA for Critical Access Hospitals Tuesday, July 26, 2016 Webinar MACRA presenters Harold D. Miller, President & CEO CHQPR Claudia Sanders, Sr. Vice President, Policy Development Andrew Busz, Policy Director,

More information

RE: File code CMS-1439-IFC Medicare Program; Final Waivers in Connection With the Shared Savings Program

RE: File code CMS-1439-IFC Medicare Program; Final Waivers in Connection With the Shared Savings Program January 3, 2012 Marilyn Tavenner Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1439-IFC P.O. Box 8013 Baltimore, MD 21244-8013 Daniel

More information

The National ACO, Bundled Payment and MACRA Summit. Success in Physician Led Bundles

The National ACO, Bundled Payment and MACRA Summit. Success in Physician Led Bundles The National ACO, Bundled Payment and MACRA Summit Success in Physician Led Bundles Disclaimer This material and/or presentation is provided for guidance and/or illustrative purposes only and should not

More information

Reinventing Health Care: Health System Transformation

Reinventing Health Care: Health System Transformation Reinventing Health Care: Health System Transformation Aspen Institute Patrick Conway, M.D., MSc CMS Chief Medical Officer Director, Center for Clinical Standards and Quality Acting Director, Center for

More information

The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010

The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010 The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010 This document is a summary of the key health information technology (IT) related provisions

More information

Moving the Dial on Quality

Moving the Dial on Quality Moving the Dial on Quality Washington State Medical Oncology Society November 1, 2013 Nancy L. Fisher, MD, MPH CMO, Region X Centers for Medicare and Medicaid Serving Alaska, Idaho, Oregon, Washington

More information

Joint Statement on Ambulance Reform

Joint Statement on Ambulance Reform Joint Statement on Ambulance Reform Policymakers Should Examine Short- and Intermediate-Term Policies to Promote Innovation in the Delivery of Emergency and Non- Emergency Care Provided by Ambulance Services

More information

Summary of U.S. Senate Finance Committee Health Reform Bill

Summary of U.S. Senate Finance Committee Health Reform Bill Summary of U.S. Senate Finance Committee Health Reform Bill September 2009 The following is a summary of the major hospital and health system provisions included in the Finance Committee bill, the America

More information

MACRA Frequently Asked Questions

MACRA Frequently Asked Questions Following the release of the Quality Payment Program Interim Final Rule, the American Medical Association (AMA) conducted numerous informational and training sessions for physicians and medical societies.

More information

QUALITY AND COMPLIANCE

QUALITY AND COMPLIANCE 2015 HCCA SOUTHEAST CONFERENCE JANUARY 23, 2015 QUALITY AND COMPLIANCE Katie Fink Donna Lewis Susan Walberg Presenters Katie Fink Senior Counsel Office of Counsel to the Inspector General U.S. Department

More information

ACO REVIVAL. Medicare Shared Savings Program Final Regulation Overview. Blue & Co., LLC Healthcare Reform Symposium Thursday, November 3, 2011

ACO REVIVAL. Medicare Shared Savings Program Final Regulation Overview. Blue & Co., LLC Healthcare Reform Symposium Thursday, November 3, 2011 ACO REVIVAL Medicare Shared Savings Program Final Regulation Overview Blue & Co., LLC Healthcare Reform Symposium Thursday, November 3, 2011 11/03/2011 1 Introductions John Redding, MD, MBA Manager Healthcare

More information

Preparing for DSRIP: Legal and Strategic Issues for Long-Term Care Providers. LeadingAge New York Webinar

Preparing for DSRIP: Legal and Strategic Issues for Long-Term Care Providers. LeadingAge New York Webinar Preparing for DSRIP: Legal and Strategic Issues for Long-Term Care Providers LeadingAge New York Webinar November 10, 2014 Tracy E. Miller, Esq. Health Care Group Bond, Schoeneck & King, PLLC Delivery

More information

Washington, DC Washington, DC Washington, DC Washington, DC 20515

Washington, DC Washington, DC Washington, DC Washington, DC 20515 The Honorable Dave Camp The Honorable Fred Upton Chairman Chairman Committee on Ways and Means Energy and Commerce Committee U.S. House of Representatives U.S. House of Representatives Washington, DC 20515

More information

Medicare Fee-For Service Provider Utilization & Payment Data Inpatient Public Use File: A Methodological Overview

Medicare Fee-For Service Provider Utilization & Payment Data Inpatient Public Use File: A Methodological Overview Medicare Fee-For Service Provider Utilization & Payment Data Inpatient Public Use File: A Methodological Overview May 30, 2014 Prepared by: The Centers for Medicare and Medicaid Services, Office of Information

More information

Stark Law Reform: Is It Time?

Stark Law Reform: Is It Time? Stark Law Reform: Is It Time? Kathy H. Butler Kathy H. Butler is an Officer fic and the Manager of the Health Law Practice Group at Greensfelder,,Hemker & Gale, P.C. CHer practice focuses on representation

More information

Alternative Payment Models for Behavioral Health Kim Cox VP, Provider Network

Alternative Payment Models for Behavioral Health Kim Cox VP, Provider Network Alternative Payment Models for Behavioral Health Kim Cox VP, Provider Network Kim Cox Vice President, Provider Network, Optum Kim Cox is Vice President of Provider Network. She joined Optum in February

More information

Division C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A

Division C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A Division C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A Sec. 15001. Development of Medicare study for HCPCS versions of MS-DRG codes

More information

Health Reform and IRFs

Health Reform and IRFs American Medical Rehabilitation Providers Association 8 th Annual AMRPA Educational Conference New Orleans, LA Health Reform and IRFs Planning Today for Success Tomorrow October 14, 2010 Agenda Introduce

More information

April, 2007 QUESTIONABLE PRACTICES BY HOSPICES AND NURSING HOMES UNDER HEALTH CARE FRAUD AND ABUSE RULES

April, 2007 QUESTIONABLE PRACTICES BY HOSPICES AND NURSING HOMES UNDER HEALTH CARE FRAUD AND ABUSE RULES HOSPICE AND PALLIATIVE CARE PRACTICE GROUP: Mary H. Michal, Chair Linda Dawson Meg S.L. Pekarske Matthew K. McManus LONG TERM CARE AND SENIOR HOUSING PRACTICE GROUP: Robert J. Heath, Chair Burton A. Wagner

More information

Bundled Payments KEY CAPABILITIES. for working with the Comprehensive Care for Joint Replacement (CJR) model

Bundled Payments KEY CAPABILITIES. for working with the Comprehensive Care for Joint Replacement (CJR) model Bundled Payments KEY CAPABILITIES for working with the Comprehensive Care for Joint Replacement (CJR) model CJR Takes Aim at Variations in Care Cost and Quality Hip and knee replacements are among the

More information

Accountable Care Organizations: Organizational and Legal Structures; Governance

Accountable Care Organizations: Organizational and Legal Structures; Governance Accountable Care Organizations: Organizational and Legal Structures; Governance California Association of Physician Groups (CAPG) May 4, 2011 Palm Desert, CA Dennis S. Diaz, Esq. Davis Wright Tremaine

More information

Q & A: CCIP and HCIP Program Templates & Implementation Protocols

Q & A: CCIP and HCIP Program Templates & Implementation Protocols All-Payer Model Amendment Webinar Series- Webinar 6 Q & A: CCIP and HCIP Program Templates & Implementation Protocols January 13, 2017 Welcome and Introduction Donna Kinzer, Executive Director, HSCRC CMMI

More information

Summary of CMMI Accountable Health Communities Model

Summary of CMMI Accountable Health Communities Model Overview: On Jan. 5, 2016, the Center for Innovation (CMMI) announced the Accountable Health Communities Model (AHC). Given that many of the biggest drivers of healthcare costs and outcomes are unmet health

More information

Transitioning Care to Reduce Admissions and Readmissions. Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH

Transitioning Care to Reduce Admissions and Readmissions. Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH Transitioning Care to Reduce Admissions and Readmissions Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH Disclaimer: Potential for Error Type One Error Rejecting the null hypothesis when it is true

More information

Bending the Health Care Cost Curve in New York State:

Bending the Health Care Cost Curve in New York State: Bending the Health Care Cost Curve in New York State: Integrating Care for Dual Eligibles October 2010 Prepared by The Lewin Group Acknowledgements Kathy Kuhmerker and Jim Teisl of The Lewin Group led

More information

ACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT

ACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT ACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT The Centers for Medicare and Medicaid Services Kate Goodrich, MD MHS Director, Clinical Standards & Quality Chief Medical Officer 1 DISCLAIMERS

More information

Bundled Payment Primer

Bundled Payment Primer Bundled Payment Primer CMS Opened Application February 14, 2014 Why this matters to you! Bundling is a New Business Model Bundling is a focused opportunity to manage risk and achieve gain Control of a

More information

Health Care Evolution

Health Care Evolution Health Care Evolution Patient-Centered Medical Home to Clinical Integration & Accountable Care Ken Bertka, MD bertka@mindspring.com 419-346-8719 Agenda Top 3 Challenges of Health Care Reform PCMH & ACO

More information

Partnering with hospitals to create an accountable care organization Elias N. Matsakis, Esq.

Partnering with hospitals to create an accountable care organization Elias N. Matsakis, Esq. Partnering with hospitals to create an accountable care organization Elias N. Matsakis, Esq. There are many opportunities for physicians and hospitals to affiliate and clinically integrate so as to enable

More information