The team at Colorado prepared an environmental analysis of payment reform, and for a number of years, was engaged in a number of Colorado state initiatives for state-wide bundling in Medicaid and the private sector. Colorado viewed the model as an expansion of a previous demonstration model – this familiarity with the payment model and evidence of cost savings helped minimize the associated risks. Ms. Kissick worked with the American Association of Medical Colleges (AAMC), a convener under contract from Medicare to assist with pilot participation, to create a program to begin in January 2014.
Under the BPCI, participants had the option to choose from one of four models; Colorado chose a 30-day, model 4 bundle. This model utilized prospective payments such that the hospital would receive a single, lump sum payment from Medicare and then distribute that payment among all of the providers involved in the episode of care – and if their costs exceed the budget, Colorado would absorb the extra costs. When compared to fellow BPCI participants, 116 institutions implemented a CHF bundle, with Colorado being the only institution to opt for a 30-day model; others all chose longer time periods (60–90 days).
BPCI makes hospitals financially responsible for services provided if a readmission occurs. For example, CMS would not pay claims for CHF related services provided at Colorado within 30 days of the anchor hospitalization. In addition, for any CHF-related services provided at another hospital, Colorado would be financially responsible for the total payments made during that readmission.
The team at Colorado prepared an environmental analysis of payment reform, and for a number of years, was engaged in a number of Colorado state initiatives for state-wide bundling in Medicaid and the private sector. Colorado viewed the model as an expansion of a previous demonstration model – this familiarity with the payment model and evidence of cost savings helped minimize the associated risks. Ms. Kissick worked with the American Association of Medical Colleges (AAMC), a convener under contract from Medicare to assist with pilot participation, to create a program to begin in January 2014.Under the BPCI, participants had the option to choose from one of four models; Colorado chose a 30-day, model 4 bundle. This model utilized prospective payments such that the hospital would receive a single, lump sum payment from Medicare and then distribute that payment among all of the providers involved in the episode of care – and if their costs exceed the budget, Colorado would absorb the extra costs. When compared to fellow BPCI participants, 116 institutions implemented a CHF bundle, with Colorado being the only institution to opt for a 30-day model; others all chose longer time periods (60–90 days).BPCI makes hospitals financially responsible for services provided if a readmission occurs. For example, CMS would not pay claims for CHF related services provided at Colorado within 30 days of the anchor hospitalization. In addition, for any CHF-related services provided at another hospital, Colorado would be financially responsible for the total payments made during that readmission.
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