quality, previous column, note dominant program? Check all that apply. 2: FFS-based Shared-savings with model in detail box in cell Note most dominant in next quality, column 3: Non-FFS-based Shared-savings with quality, 4: FFS plus pay for performance, 5: Full capitation with quality, 6: Partial or condition-specific capitation with quality, 7: Bundled payment with quality, 8: FFS-based non-visit functions, 9: Non-FFS-based non-visit functions, 10: Non-payment for specific services that were preventable or services that were unnecessary (detail in row below), 11: Other non-FFS based payment reform models (provide details in box below) If you have a payment reform Multi, Checkboxes. 65 words. 14 1: N/A, model that includes policies on 2: Ambulatory care sensitive non-payment for specific services admissions, associated with complications 3: Healthcare acquired conditions that were preventable or services (HACs) also known as that were unnecessary, for which conditions, 4: Preventable Admissions, outcomes are these policies in 5: Serious Reportable Events (SREs) place? that are not HACs, 6: Never Events, 7: Early elective induction or cesarean, 8: Other - (provide details in next column) Which base payment Single, Radio group. 50 words. 15 methodology does your program 1: Capitation without quality, 2: Salary, use? 3: Bundled or episode-based payment without quality, 4: FFS (includes discounted fees, fixed fees, indexed fees), 5: Per diem, 6: DRG, 7: Percent of charges, 8: Other - (provide details in next column) What types of providers are Multi, Checkboxes. 50 words. 16 participating in your program? 1: Primary care physicians, 2: Physician Specialists (e.g., Describe incentives for Oncology, Cardiology, etc.) – describe participation. in next column, 3: RNs/NP and other non-physician providers, 4: Hospital inpatient,
program? Check all that apply. Note most dominant in next column quality, 2: FFS-based Shared-savings with quality, 3: Non-FFS-based Shared-savings with quality, 4: FFS plus pay for performance, 5: Full capitation with quality, 6: Partial or condition-specific capitation with quality, 7: Bundled payment with quality, 8: FFS-based non-visit functions, 9: Non-FFS-based non-visit functions, 10: Non-payment for specific services that were preventable or services that were unnecessary (detail in row below), 11: Other non-FFS based payment reform models (provide details in box below) previous column, note dominant model in detail box in cell If you have a payment reform model that includes policies on non-payment for specific services associated with complications that were preventable or services that were unnecessary, for which outcomes are these policies in place? Multi, Checkboxes. 1: N/A, 2: Ambulatory care sensitive admissions, 3: Healthcare acquired conditions (HACs) also known as conditions, 4: Preventable Admissions, 5: Serious Reportable Events (SREs) that are not HACs, 6: Never Events, 7: Early elective induction or cesarean, 8: Other - (provide details in next column) 65 words. 14 Which base payment methodology does your program use? Single, Radio group. 1: Capitation without quality, 2: Salary, 3: Bundled or episode-based payment without quality, 4: FFS (includes discounted fees, fixed fees, indexed fees), 5: Per diem, 6: DRG, 7: Percent of charges, 8: Other - (provide details in next column) 50 words. 15 What types of providers are participating in your program? Describe incentives for participation. Multi, Checkboxes. 1: Primary care physicians, 2: Physician Specialists (e.g., Oncology, Cardiology, etc.) – describe in next column, 3: RNs/NP and other non-physician providers, 4: Hospital inpatient, 50 words. 16
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