As we continue our bundled payment series (see here and here), focused on a new payment model which combines fee for service reimbursement and capitation, we’d like to introduce you to the second and third bundled payment models. The following explains each:
Retrospective Acute Care Hospital Stay plus Post-Acute Care: This model is initiated by a patient admission, either to a participating acute care hospital, or by a participating physician group. The bundle includes all costs associated with hospitalization as well as all post acute and other related services during that episode of care which can end after 30, 60, or 90 days after a hospital admission. Participants will be able to choose from 48 different clinical condition bundles. All providers are paid as usual by CMS but then costs are reconciled with predicted bundle costs retrospectively every quarter.
Retrospective Post-Acute Care Only: This episode of care will be generated by an acute care hospital stay and will start at initiation of post-acute care services with participating skilled nursing facilities, inpatient rehab facilities, and long-term care hospitals, or home health agencies. The services in this episode must begin within 30 days of discharge from inpatient stay and would end 30, 60, or 90 days after initiation of the episode. Participants in this model will be able to choose from 48 different clinical condition bundles.
Stay tuned to learn about the final model and if you need more information on bundled payments, please call us at (203) 294-6659.