MODEL 1 Inpatient Stay Post-discharge Inpatient Stay – plus Services Only Only FEATURE Inpatient Stay Services Only Eligible Physician group Physician group Physician group Physician group Awardees practices practices practices practices Acute care Acute care Acute care care hospitals paid hospitals paid hospitals paid hospitals paid under the IPPS under the IPPS under the IPPS under the IPPS Health systems Health systems Health systems Health systems Long-term care hospitals organizations organizations organizations Inpatient Conveners of Post-acute rehabilitation Conveners of participating providers facilities participating health care health care providers providers Conveners of Skilled nursing participating facilities health care providers Home health agency organizations Conveners of participating health care providers Discounted IPPS Retrospective Retrospective Prospectively set Payment of Bundle and payment; no comparison of comparison of payment Target Price separate target target and target price and price actual FFS actual FFS payments payments Clinical All MS-DRGs Applicants to Applicants to Applicants to Conditions propose based on propose based on propose based on Targeted MS-DRG for MS-DRG for MS-DRG for inpatient hospital inpatient hospital inpatient hospital stay stay stay Types of Inpatient hospital Inpatient hospital Post-acute care Inpatient hospital Services services and physician services and physician Included in services services Bundle
FEATURE MODEL 1 – Inpatient Stay Only Inpatient Stay plus Services Post-discharge Services Only Inpatient Stay Only Eligible Awardees Physician group practices Acute care hospitals paid under the IPPS Health systems organizations Conveners of participating health care providers Physician group practices Acute care hospitals paid under the IPPS Health systems organizations Post-acute providers Conveners of participating health care providers Physician group practices Acute care hospitals paid under the IPPS Health systems Long-term care hospitals Inpatient rehabilitation facilities Skilled nursing facilities Home health agency organizations Conveners of participating health care providers Physician group practices care hospitals paid under the IPPS Health systems organizations Conveners of participating health care providers Payment of Bundle and Target Price Discounted IPPS payment; no separate target price Retrospective comparison of target and actual FFS payments Retrospective comparison of target price and actual FFS payments Prospectively set payment Clinical Conditions Targeted All MS-DRGs Applicants to propose based on MS-DRG for inpatient hospital stay Applicants to propose based on MS-DRG for inpatient hospital stay Applicants to propose based on MS-DRG for inpatient hospital stay Types of Services Included in Bundle Inpatient hospital services Inpatient hospital and physician services Post-acute care services Inpatient hospital and physician services
AHCA_201110_CMMIBundledPaymentInitiative_OverviewAndMemberSupport_FINAL_20111010.docx