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2 posts from September 2015


Bundled Payment and CMS's Proposal To Mandate Bundled/Episodic Payment for Hip & Knee Surgery: A Conversation with Harold Miller (September 29th)

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Bundled or episodic health care payment for a clinically defined medical episodes of care has been used since at least the 1980s.  However, recently CMS has initiated two bundled payment demonstrations, the Bundled Payment for Care Improvement Demonstration (BPCI) that bundles care for 48 (DRG) episodes of care began in 2013 and more recently CMS proposed the Chronic Care for Joint Replacement (CCJR) demonstration this past July.   Considered the middle ground between fee for service reimbursement and capitated payment the jury is still out whether bundled payments can be designed to reduce cost growth and improve care quality and patient outcomes.      

During this 22 minute conversation, Mr. Miller addresses five aspects of bundled payment and how well or not these aspects are addressed in CMS's recent CCJR proposal to mandate bundled payment for hip and knee replacement surgeries in 75 markets nationally.  Theses aspects are: how well or not bundled payment addresses the underlying problems of fee for service reimbursement and whether bundled payments incent or not care innovation; what types of patients are best served under bundled payment arrangements; how best providers can organize to be effective and efficient under these arrangements; how well bundled payments address over-utilization; and, how episodic payments can be integrated with wider care coordination and whole person care.   

HaroldMillerHarold D. Miler is the President and CEO of the Center for Healthcare Quality and Payment Reform.  He also serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University.   From 2008 to 2013, Mr. Miller served as President and CEO of the Network for Regional Healthcare Improvement, the national association of the Regional Health Improvement Collaboratives.   From 2006 to 2010, Mr. Miller serves as the Strategic Initiatives Consultant to the Pennsylvania Governor's Office of Policy Development, Associate Dean of the Heinz School of Public Policy and Management at Carnegie Mellon, Executive Director of the PA Economy League, Director of the SW PA Growth Alliance and the President of the Allegheny Conference on Community Development.   Mr. Miller has worked in more than 30 states and metropolitan regions to help physicians, hospitals, employers, health plans, and government agencies design and implement payment and delivery system reforms.  He assisted CMS with the implementation of its Comprehensive Primary Care Initiative in 2012.  Mr. Miller also serves on the Board of Directors of the National Quality Forum.

For more on bundled payment see Mr. Miller's, "Bundling Better, How Medicare Should Pay for Comprehensive Care" published September 2015, at: http://www.chqpr.org/index.html.


Medicare, Home Health and Value-Based Purchasing: A Conversation with Sherill Mason (September 23rd)

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This past July CMS announced a proposed demonstration that would either reduce or increase a Medicare home health agency's reimbursement based on quality performance.   With a rapidly aging and growing Medicare population home health utilization and costs have risen significantly over the past decade.  Per MedPAC, between 2000 and 2012 total Medicare home health spending increased 64 percent.  However, home health agency quality performance has been limited.  For example, again per MedPAC, less than half of all Medicare home health patients in 2013 showed improvement in medication management and only 65 percent showed improvement in pain management.    

During this 22 minute discussion Ms. Mason explains the several, if not numerous reasons, why CMS announced this demonstration, how it will work, e.g., how quality will be measured or what quality metrics will be used, what are the specific financial incentives, in what states the demo will be conducted, when it will begin and for how long, and what are some of the perceived pros and cons of the demonstration as proposed.   

Sherill Mason is currently Principal, Mason Advisers, where she provides strategic planning, Sherill-mason[1]program development and operations analysis for post acute care providers including senior living and nursing home facilities, home health, hospice, long term acute care hospitals, in patient rehabilitation facilities, and long term care pharmacy.  Previously, Sherill she served as a Vice Presient to the Marwood Group, a healthcare industry consultant, as Senior Vice President at Sunrise Senior Living and as a Director at KPMG.   Among other current professional activities Sherill currently is a Guest Lecturer at the University of Pennsylvania School of Nursing.  She received her RN diploma and training at the Englewood Hospital School Nursing and a BA in American Studies from Eckerd College.  

For information regarding CMS's proposed value-based home health demonstration go to: https://www.cms.gov/center/provider-Type/home-Health-Agency-HHA-Center.html