CMMI Bundled Payment Pilot Analysis and Reporting Overview

March 19, 2012

The webinar gives an overview of what is needed to run HCI3’s CMMI Bundled Payment Pilot Analysis Freeware including decrypting, decompressing, and preparing the CMS data files. It also looks at additional tools and resources including the Reporting Add-On for…

April 16, 2012

PROMETHEUS: New Payment System, New Keys to Success

Criticism of the predominant payment systems in the United States is rampant. From the Institute of Medicine's call for payment reform in order to improve quality, to physician dissatisfaction with administrative burdens, to employer concerns about escalating costs, no one…

April 10, 2012

In Common Cause for Quality, Part 1

New Hospital-Physician Collaborations

The call for improved quality dominates the health care landscape. The Institute of Medicine’s Crossing the Quality Chasm, a dramatic increase in transparency, the advent of pay for performance and the 100,000 Lives Campaign are pressing all types of health…

April 10, 2012

In Common Cause for Quality Part 2

PROMETHEUS Payment® and Principles of Engagement

Quality demands alone ought to motivate hospitals to seek ways to collaborate more effectively with physicians. But the most significant lever to better hospital-physician relationships might be a different payment system. Pay for performance, while a positive development, is generally…

April 10, 2012

The Prometheus Payment Program: A Legal Blueprint

Pay for performance (P4P) programs are sweeping the country in both public and private health insurance. Responding to the Institute of Medicine's call for new payment models to really advance quality, these initiatives are typically designed to motivate physicians to…

April 10, 2012

Can Health Care Come With a Warranty?

From the time I was in grade school until just a few years ago, my parents owned a series of small neighborhood businesses. The first was a corner convenience store in an Italian neighborhood; eventually they traded up to three…

April 10, 2012

The PROMETHEUS Model: Bringing Healthcare into the Next Decade

From: Annals of Health Law Advance Directive p274-284

The United States’ current healthcare system has long been structured to emphasize the quantity of health care over the quality of health care. Such a focus of quantity is evident in the fee-for service structure, where providers are paid a specified…

April 10, 2012

Transitioning to Value

PROMETHEUS Payment Pilot Lessons

As the healthcare system begins to transition from volume-based to value-based payment, industry stakeholders are experimenting with payment models that can effectively align incentives to generate high-quality outcomes while reducing the cost of care. Participants in a pilot of the…

April 9, 2012

Episode of Care Analysis Reveals Sources of Variations in Costs

Objectives: To understand and reveal the under­ lying sources of inter­ and intraplan variation in a selected number of chronic and procedural episodes. Study Design: Analysis of allowed claims from 9 regional health plans covering commercially insured populations in different…

April 9, 2012

CMMI Bundled Payment Reporting Application

HCI3, working with BNL Consulting, has developed a reporting add-on to our CMMI Bundled Payment Analytic Package. The Reporting Application is a bolt-on, dynamic reporting structure that allows the user to filter the results of their analysis with HCI3's CMMI…

March 22, 2012

CMMI Bundled Payment Pilot Application Tables

Applicants for Models 2, 3, and/or 4 of the CMMI Bundled Payments for Care Improvement pilot will need to include the list of MS-DRG exclusions and the list of Principal ICD-9 Diagnosis code exclusions applied to the episode definitions for…

March 22, 2012

CMMI Bundled Payment Pilot Analysis Templates

HCI3 has provided analysis templates that can be populated by specific reports generated from Model 2, Model 3, and/or Model 4 data runs. The user can simply copy and paste the entire report into the corresponding tab in the analysis…

March 22, 2012

Evaluating and Negotiating Emerging Payment Options

This “how-to” manual is intended to help physicians who are considering transitioning from fee-for-service payment to risk-based reimbursement. It covers the nuts and bolts of payment systems based on a physician’s ability to stay within a specified budget for health…

March 15, 2012

HCI3 Improving Incentives Issue Brief: Hospital Bed Supply and Hospitalizations

A Tale of Four Cities

Objective: To understand the relationship between the supply of hospital beds and the frequency of hospitalizations in four comparable U.S. cities. Methods: The Pittsburgh Business Group on Health (PBGH) commissioned a study that compares, among other indicators, the number of…

March 13, 2012

Medicare Spends Less Than Private Insurers On Knee Replacements

The federal government spends 14 percent less than private insurers for knee replacement surgery and its related costs, even though Medicare patients are older and twice as likely to be readmitted to the hospital, a research paper released this week…

March 9, 2012

An Experiment Shows That A Well-Designed Report On Costs And Quality Can Help Consumers Choose High-Value Health Care

Advocates of health reform continue to pursue policies and tools that will make information about comparative costs and resource use available to consumers. Reformers expect that consumers will use the data to choose high-value providers—those who offer higher quality and…

March 9, 2012

HCI3’s CMMI Bundled Payment Analysis Package Instructions

The download below includes instructions for the SAS based Freeware CMMI Bundled Payment Analysis Package. The package itself is available here. The packaged application will help you get an analysis of the historical Medicare data provided to potential Applicants…

March 6, 2012

Medicare: Lack of Price Transparency May Hamper Hospitals’ Ability to Be Prudent Purchasers of Implantable Medical Devices

GAO: Report to the Chairman, Committee on Finance, U.S. Senate

Why GAO Did This Study — Implantable medical devices (IMD)— including a variety of cardiac and orthopedic devices provided to Medicare beneficiaries in inpatient or outpatient hospital settings—represent a significant share of hospitals’ supply costs. Hospitals purchase IMDs directly from manufacturers…

February 24, 2012

HCI3 Improving Incentives Issue Brief – Analysis of Medicare and Commercial Insurer-Paid Total Knee Replacement Reveals Opportunities for Cost Reduction

Objective: To understand the variation in episode costs in total knee replacement (TKR) in Medicare and commercially insured patients and to estimate potential savings achievable with a bundled payment program. Patients and Methods: We performed a retrospective analysis of claims…

February 23, 2012

Reforming Payments to Healthcare Providers

The Key to Slowing Healthcare Cost Growth While Improving Quality?

The seemingly intractable debate about how to slow the growth of healthcare costs in the United States and elsewhere has traditionally boiled down to efforts to limit prices and quantities directly. In public healthcare programs, the focus in the United…

February 23, 2012

Sources of Regional Variation in Medicare Part D Drug Spending

Sources of regional variation in spending for prescription drugs under Medicare Part D are poorly understood, and such variation may reflect differences in health status, use of effective treatments, or selection of branded drugs over lower-cost generics… We analyzed 2008…

February 10, 2012

Medicare: Lack of Price Transparency May Hamper Hospitals’ Ability to Be Prudent Purchasers of Implantable Medical Devices

GAO: Report to the Chairman, Committee on Finance, U.S. Senate

From 2004 through 2009, expenditures for hospital IMD procedures increased from $16.1 billion to $19.8 billion, an increase of 4.3 percent per year—a rate equal to that of Medicare spending for other hospital procedures. While cardiac and orthopedic procedures accounted…

February 10, 2012

What is an Episode of Care Engine?

Recently in an article on episode of care purchasing written for the New England Journal of Medicine, Rob Mechanic of Brandeis University, noted that several software firms “are developing ‘engines’ to automatically convert fee-for-service claims into episode-based payments”1. He also…

February 10, 2012

Summary of the National Demonstration Project and Recommendations for the Patient-Centered Medical Home

This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care. The NDP was…

February 8, 2012

Fundamental Reform of Payment for Adult Primary Care

Comprehensive Payment for Comprehensive Care

Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment…

February 8, 2012