Bundled Payments for Care Improvement Learning & Resources Area

General Resources

• Model 2 background document (PDF)
• Model 3 background document (PDF)
• Model 4 background document (PDF)
• Bundled Payments for Care Improvement Toolkit (PDF)
• BPCI Episodes List (XLS)
• BPCI Models 2-4 Discounts Table (PDF)
• BPCI Models 2-4 Part A & B Exclusions: 2016 (XLS)  |  2017 (XLS)  |  2018 (XLS)
• PGP Reassignment CPI Screening Results Part 1 (2015 - present) (XLS)*
• PGP Reassignment CPI Screening Results Part 2 (2015 - present) (XLS)*
• PGP Reassignment CPI Screening Results Q2 2015 (XLS)*
• PGP Reassignment CPI Screening Results Q3 2015 (XLS)*
• PGP Reassignment CPI Screening Results Q4 2015 (XLS)*
• PGP Reassignment CPI Screening Results Q1 2016 (XLS)*
• PGP Reassignment CPI Screening Results Q2 2016 (XLS)*
• PGP Reassignment CPI Screening Results Q3 2016 (XLS)*
• PGP Reassignment CPI Screening Results Q4 2016 (XLS)*
• PGP Reassignment CPI Screening Results Q1 2017 (XLS)*

* Data available in these files are for research purposes. Additional adjustments have been made to these files prior to their use by CMS; these adjustments include both the addition and removal of NPIs.

ASPE Reports 

The HHS Assistant Secretary for Policy and Evaluation (ASPE) has conducted several research projects in the area of Medicare acute and post acute care episodes. The reports model the impact on potential payment bundles, provide cross-sectional and longitudinal analysis, examine differences in payments by geographic area using standardized payments, and analyze changes in post acute care use based on different episode definitions.

• The first ASPE report reflects 18 sample episode definitions.
• The second ASPE report reflects a modified sub-set of those episodes.

Definitions 

The following two chart books provide additional data on the implications of different episode definitions. The Center for Medicare and Medicaid Innovation is making these chart books available to Bundled Payments for Care Improvement applicants as a resource, but applicants should propose their own episode definitions in accordance with the parameters outlined in the Request for Applications.

• Analysis of Post Acute Care Episode Definitions File - This original chart book was so large it presented downloading difficulty for some visitors. Therefore, the original chart book has been divided into nine smaller files below for easier accessibility:

• Post-Acute Care Episodes Expanded Analytic File (PDF)

Contractual Considerations (PDF) – A resource document that analyzes the issues related to contracts and agreements in an environment where hospitals, physicians, and other providers will interact in significantly new ways. Toward that end, this document describes the means of establishing bundled payment specific components of contracts among organizations, preparing these organizations to receive bundled payments from CMS or other payers. The Center for Medicare and Medicaid Innovation is making this analysis available to Bundled Payments for Care Improvement applicants as a resource, however the views, opinions and/or findings contained in this document are the authors’ own and do not constitute any official government position, policy or decisions.

Previous Webinars

• Webinar: Bundled Payments for Care Improvement Initiative Overview and Basic Parameters
• Webinar: Bundled Payments for Care Improvement Initiative Winter Open Period Models 2-4

Accelerated Development Learning Session (ADLS) Webinar Series: Bundled Payments

ADLS #6: Building an Effective Gainsharing Program – April, 6, 2012

Faculty will review key components of gainsharing program design and administration, providing personal lessons learned from the Medicare Hospital Gainsharing Demonstration, and examples of how that model and others could operate within varied clinical areas and organizational structures. Presentations will emphasize methods to ensure program effectiveness in incentivizing behavior change, credibility with all stakeholders and multi-year sustainability.

ADLS #5: Contractual and Governance Issues among Providers in Bundled Payments – March 22, 2012

Bundled payments necessarily entail allocation of a single source of dollars, or a reconciled budget, to disparate providers. In the mid-90s, disputes over how to allocate monies contributed to the relative failure of a number of PHOs. In this webinar, Faculty will outline contractual structures and provisions to ensure that payments are consistent with the expectations of the participants. Faculty will not address Stark, anti-kickback or gainsharing issues.

ADLS #4: What to Pack in Your Bundle: Episode Selection, Definition and Clinical Management for Care Improvement – March 13, 2012

Faculty will review criteria for selecting conditions or procedures to target for bundled payment, discuss requirements and options for episode definition for those targets, and provide examples of clinical and operational strategies to maximize improvement in care quality and efficiency within defined episodes.

ADLS #3: Data-Driven Continuous Quality and Efficiency Improvement – February 21, 2012

Faculty will share principles and techniques for engaging quality leaders and physician champions, along with models for data exchange to support a continuous organizational effort to achieve better health, better care and reduced costs through improvement.

ADLS #2: Transform Care Today: Strategies and Tactics Across the Continuum – February 14, 2012

Faculty will share their insights on topics including strategies to develop physician leadership, keys to success in care redesign, the critical hand-off from acute to post-acute care, how acute providers can successfully work with post-acute providers and how post-acute providers can lead the way.

Implementing Bundled Payment: Ready, Set, Go – January 18, 2012

For business and clinical representatives from organizations or state agencies that are developing bundled payment programs for either private- or public-sector populations.