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How Hospitals, Physicians, and Others Can Get Organized to Participate in CMS’ Bundled Payment Pilot

Seeking to improve patient care through payment innovation, the federal Centers for Medicare & Medicaid Innovation (CMMI announced its Bundled Payments for Care Improvement initiative in August. Model 2 of this initiative offers a fairly flexible approach to hospital-physician collaboration around DRG-based episodes.

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That Was Then, This Is Now

In 2006, the Commonwealth Fund and the Robert Wood Johnson Foundation (RWJF) funded the development of the PROMETHEUS Payment methodology, a patient-centered episode of care logic that bundles payment around a particular condition or procedure. In addition to development, RWJF also provided funding for a 3-year implementation period, from 2007 to 2010, during which the PROMETHEUS model would be pilot tested in various healthcare markets across the country. Since then, implementations of the PROMETHEUS model have expanded from the original four pilot sites to several other sites.

Guidelines for Benefits Operations in Episode of Care Contracting

ECR Instruction Guide Addendum for the CMMI Bundled Payment Pilot

The PROMETHEUS ECR analytics can be used to assist prospective CMMI Bundled Payment Pilot sites in selecting their DRG(s) of choice and creating a bundled episode price for each DRG selected. The following will help to instruct those running Medicare claims data through the SAS analytics how to best map DRGs to the PROMETHEUS ECRs. 

Applicable ECRs: HCI3 has identified 10 ECRs that could be capitalized on for the CMMI pilot: