CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI...

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CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016

Transcript of CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI...

Page 1: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

CMS AMI and CABG Bundled Payment

Initiative AMGA HF Collaborative

December 13, 2016

Page 2: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

Collaborative Learnings − HF Correlation to AMI and CABG Bundled Payments

CMS AMI & CABG Bundled Payment

Programs

− Bundled Payment Background − AMI & CABG and HF Relationship

Survey Background − Survey Objectives − Target Audience

AMI & CABG Success Factors and Areas of

Opportunity

− The Key Success Factors − Main Obstacles and Opportunities for Improvement

Discussion How to leverage collaborative work to prepare for management of AMI & CABG bundled payments

Agenda

Page 3: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

Care Team Coordination Using process mapping to standardize care

HF Collaborative

AMI & CABG Bundled

Payments

Patient Stratification Identifying and managing high risk patients

Medication Management Communicating about medication changes

Collaborative Learnings

Page 4: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

About the Bundle

• 90-day episode of care

• Retrospective with annual

reconciliation

• Participants are 98 randomly

selected MSAs

• Payment for Quality

• CMS is offering an incentive for

cardiac rehab services post-discharge

• Impact on MACRA participation

October 2016

Deadline for Proposed Rule Comments

Late 2016/Early 2017

Final Rule Publication and MSAs Announced

July 1, 2017 First Performance

Period Begins

July 2016

AMI & CABG Bundled Payment Announced

TODAY

December 31, 2017

First Performance Period Ends

AMI & CABG Bundled Payments

Included MS-DRGs

• CABG 231-236

• AMI 280-282

• PCI 246-251 with an AMI ICD-10

principal or secondary diagnosis code

Measurement Categories

• Length of Stay

• Readmission Rates

• Mortality Rates

• Patient Satisfaction Rates

Page 5: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

Survey Background Distributed from November 18- December 1

Survey objectives: • Identify potential barriers to implementing

bundled payment programs

• Determine the necessary resources to be

successful in procedure and event-based bundled

payments

• Assess bundled payments performance readiness

• Define opportunities to support heart failure

management within cardiac bundle payment

implementation

Survey Participants Targeted participants:

• Nation-wide providers at integrated delivery networks

• MD or PharmD credentials were primary respondents

Participant’s Role Specialty Care Physician

Physician Assistant, NP, Nurse Midwife,APN, etc.PharmD or pharmacy assistant

Management; Practice Manager, OfficemanagerOther (please specify)

Specialty Care Physician

Physician Extender

PharmD

Practice Management

Other*

*Other: Primary Care in leadership position: C-Suite, Executive

Clinical Council, Medical Director, Clinical Care Coordinator

Bundled Payment Survey A non-scientific study designed to provide directional information on how we might use the learning/best practices from the HF collaborative to succeed in the CABG/AMI bundles

Page 6: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

Current Bundled Payment

Performance

• Includes BPCI and CCJR

• 100% believe they have room

for improvement, but also

acknowledge that they are

doing well

• 55% of respondents are

currently participating in

bundled payment programs

How do respondents categorize their organization's potential performance?

Excellent

Very good, but withroom for improvement

Good, but still somework to do

Unsatisfactory, butmaking progress

Poor

Bundled Payment Performance

“Very Good” vs. “Good” -> Differentiating factor is extent of program infrastructure

Page 7: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

C om m on B e s t Pra ct ice s

Service Line Structure Integrated Service Lines and Care Teams:

Primary Care, Pharmacists and Quality Departments

Transition of care discharge services:

Pharmacy-based clinics (Coumadin, etc.)

Home health

Post-acute management and rehab

Tele-medicine:

Only 50% of respondents have tele-monitoring resources

Bundled Payment Implementation Teams

Designated Implementation Teams:

100% of those with a bundled payment implementation

team feel they are performing “very well with some room

for improvement”

Streamlined Processes:

Either an AMI or CABG pathway developed; pathways

include system formulary preferences

Success Factors: What do those responding “very good” have in common?

Page 8: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

Standardized Clinical Workflows

Post-Discharge Care Coordination

Staff Education

What did respondents identify as the biggest barriers to implementing AMI

and CABG bundled payment programs?

Areas of Opportunity

Page 9: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

Standardized Clinical Workflows

Post-Discharge Care Coordination

Staff Education

Expand Collaboration with Discharge Destinations

• The majority of a patient’s costs are after discharge

• Over 60% identified patient access to post discharge

services as a barrier

• Opportunities to expand:

• Pharmacy integration

• Tele-monitoring

• Coordination for Post-Discharge care

Post-Acute Facilities

Cardiac Rehab

Home Care

Primary Care

Post-Discharge Care Coordination

Page 10: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

Standardized Clinical Workflows

Post-Discharge Care Coordination

Staff Education

• Expect clinical pathways to change

• 85% plan on exploring clinical workflow process

improvements through the AMI and CABG bundled

payment initiative

• Other bundled payment programs show key steps are:

• Identifying patients

• Conducting risk stratification

• Determining appropriate discharge destination

• Establishing care coordination and transitioning

care teams

What do you see as potential barriers to implementing AMI and CABG bundled payments at your organization?

Resistance to standardization

of care

50%

Standardized Clinical Workflows

Page 11: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

Standardized Clinical Workflows

Post-Discharge Care Coordination

Staff Education

Bundled payment topics for staff education missing in respondents’ health systems…

• Develop necessary quality reports and educate staff on

responsibilities and appropriate follow-up actions

• CMS plans to monitor:

• Length of Stay

• Readmission Rates

• Mortality Rates

• Patient Satisfaction Rates

• The culture of transparent reporting

0% 10% 20% 30% 40% 50% 60%

Utilizing quality reports:Interpreting and acting on results

Impact of bundled payments

Clinical workflow training

Staff Education

Page 12: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

Bringing It All Together

• Everyone has challenges with bundled payment programs

• Keys to success include:

• Designating a care team to manage bundled payments

• Increasing access and management of post-discharge services

• Streamlining workflows, consider:

• Early identification of patients

• A process for stratifying risk

• Discharge coordination

• Incorporate primary care, quality departments, and pharmacy

• Monitor patients’ adherence, based on assessed clinical risk

• Providing education about quality reports, bundled payment impacts, and

clinical workflows

What’s Next: As you continue to implement changes from the HF collaborative, think about

how you can incorporate initiatives supporting AMI and CABG

Page 13: CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 . Collaborative

Discussion