The Centers for Medicare and Medicaid Services (CMS) is adopting new payment policies that will rapidly shift current reimbursement models that reward volume to alternative models designed to reward value and care coordination. These reforms also expand existing value-based purchasing programs that pay incentives or impose penalties based on performance in selected quality and efficiency measures.
One alternative model, bundled payments, will reimburse hospitals for services provided to patients during an episode of care. An episode starts with a hospitalization and includes services for a period of 30, 60, or 90 days post-discharge. The bundled payment covers facility and professional services delivered during the index hospitalization and post-discharge period, including hospital readmissions, skilled nursing facility, and home health care. To prepare for bundled payments, hospitals must analyze their historical performance and details about the services patients received during the episode. However, CMS does not supply hospitals with basic information necessary to accomplish this important step.
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