HCI3 Update from the Field: Letters of Intent by Applicant-Providers and Other Conveners for the Bundled Payment Pilot

Submitted by francois.debrantes@hci3.org on Thursday, September 15, 2011 - 06:14

HCI3 Update from the Field – Newtown, CT

Fall is a few days away and it's time to plant the bulbs that will come out in Spring – Many of those bulbs should be the Letters of Intent by Applicant-providers and other conveners for the Bundled Payment Pilot, and they will come out in the early Spring of 2012 when CMS awards the pilot status to those who have successfully filed applications and received high enough evaluation marks. This pilot allows for such flexibility that it's hard to conceive of anyone serious about payment reform, or delivering value, sitting it out. And in fact, anyone that is serious about delivering value is well under way in considering the details of their Letter of Intent. Some of those details include deciding on which entity will be the risk-bearing entity, formally bound to pay the downside to, or receive the upside from Medicare, and then redistribute it. Other important details include which DRGs to include in the scope of the pilot, and how the risk will be shared among the pilot participants. To shed light on the first issue, our Board Chair (and highly respected health care lawyer) Alice Gosfield, has written a short memo that describes the types of entities that could be the risk-bearer. A special callout focuses on the important role of Convener-awardee that can be taken by health plans and others. To shed light on the second, we've created a crosswalk of DRGs to PROMETHEUS ECRs . Our freeware can be used to analyze Part A and B claims after making a few modifications. A brief set of instructions explains how.

What this means to you – Physicians, hospitals, and post-acute care providers, can all participate in the CMMI Bundled Payment pilot. The only thing stopping any of them is the courage to act decisively for the good of patients and the country, and perhaps some technical concerns. The two documents referenced above are the first of several that will break down any technical concerns to implementation. Within three weeks, we plan to have them all broken down. There's not much we can do about lack of courage, though. That'll be up to the organizations' leaders. Health plans and direct-purchasing coalitions, as convener-awardees, can massively accelerate the uptake of bundled payments, and we've spent three years breaking down technical barriers for them through our implementations. The only thing stopping any of them is a desire to move away from the status quo. We'll soon find out who the sloths are. The Fall is also a good time to pull out the old dead plants, toil the beds, fertilize and mulch. We'll be pointing out which plants are dead and need to be pulled out. And we'll also be highlighting who's planted some bulbs.


Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc.
w: www.hci3.org