The initiative would expand Medicare’s present Bundled Payments for Care Improvement (BPCI) program
Work is underway at the Centers for Medicare & Medicaid Services (CMS) on development of pilot projects to test episode-based reimbursement for medical specialists in outpatient settings. The CMS Center for Medicare and Medicaid Innovation (CMMI) plans to develop the new bundled payment projects under authority granted in the Affordable Care Act to test new payment and care models under the Medicare, Medicaid and the Children’s Health Insurance Program. The initiative would essentially expand Medicare’s present Bundled Payments for Care Improvement (BPCI) program, which now covers primarily inpatient hospital services. It would mark the first time CMS has targeted a bundled payment program toward individual physicians, rather than institutions. The CMMI is planning to develop bundled specialist payment programs for:
Procedures, including common outpatients surgeries (such as colonoscopy or cataract removal) and nonsurgical treatments (such as radiation therapy), which might require specialist services care for a period of days or weeks; and
Management of complex or chronic diseases (such as an ongoing cardiac condition), which could require a specialist to work with a primary care physician to provide care over an extended period of time.
The new specialist bundled payment models would be distinct from the new payments for chronic care management slated to begin in 2015 through the Medicare Physician Fee Schedule. In February, CMMI issued a request for information on bundled payment opportunities for specialists, including specific conditions, existing models and specific quality metrics. The agency also asked for information on factors that might encourage or discourage specialists from participating in bundled payment programs.
Doug Chaet of Value Evolutions Discusses Value-based Payment Models, Where They Stand and More
September 29th 2022In this episode of Tuning In to the C-Suite, Managing Editor of Managed Healthcare Executive, Peter Wehrwein, speaks with President of Value Evolutions and MHE Editorial Advisory Board Member, Doug Chaet, FACHE, about value-based care's current standing, the status of select payment models like bundled and episodic, and more.
Listen
We conducted our annual State of the Industry survey in the early part of November 2023. The survey had 432 respondents, of whom 56% self-reported working for a payer organization (pharmacy benefit manager, insurer or self-insured employer), 34% for a provider organization and the remainder for government or an unspecified “other” category.
Read More
Parity for Mental Health — Any Progress?
October 12th 2023Laws since 1996 have sought to assure that coverage of behavioral health treatments does not take a back seat to physical medicine. Amid a national crisis in mental illness and addiction, that new world of equality has not arrived. But is it on the way?
Read More