Additional participants in CMS bundled payments pilot

The Centers for Medicare & Medicaid Service (CMS) announced that over 2,100 acute care hospitals, skilled nursing facilities, physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies transitioned to a risk-bearing implementation period in which they assumed financial risk for episodes of care.

Participants include 360 organizations that have entered into agreements with CMS to participate in the Bundled Payments for Care Improvement initiative and an additional 1,755 providers who have partnered with those organizations. CMS defines an episode of care as the set of services provided to treat a clinical condition or procedure, such as a heart bypass surgery or a hip replacement.

Through the Bundled Payments for Care Improvement initiative, CMS is testing how bundled payments for clinical episodes can result in better care, smarter spending, and healthier people.  The initiative includes four models of bundled payments tied to inpatient hospital admission. The models vary by the types of providers involved and the length of the bundle after the hospitalization.

The Bundled Payments for Care Improvement Initiative, along with a new Medicare Part A and B payment model, the Comprehensive Care for Joint Replacement Model, are part of the framework established by the Affordable Care Act to move the US health care system toward one that rewards providers based on the quality, not quantity, of care they deliver to patients.  Earlier this year, the Administration announced the goal of tying 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent of payments by 2018.