The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and changes to the Comprehensive Care for Joint Replacement Model final rule on Wednesday, February 22, 2017, from 12:00 p.m. – 1:00 p.m. EST. The final rule was displayed at the Federal Register on December 20, 2016 and is effective on February 18, 2017.
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CMS Innovation Center
http://innovation.cms.gov
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Staff from the CMS Innovation Center and the Center for Medicare and CHIP Services hosted a webinar that provided an overview of the Strong Start initiative and the application process and requirements for the Medicaid funding opportunity.
More at: http://innovations.cms.gov/resources/StrongStart_overview.html
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
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The CMS Innovation Center hosted a webinar on Tuesday, June 10, 2014 from 12:00pm - 1:00pm EDT that focused on all components of the Round Two Model Test Award opportunity. The webinar also highlighted the requirements for submitting an application as well as considerations regarding the application review process.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
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The State Innovation Models initiative is a competitive funding opportunity for states to design and test multi-payer payment and service delivery models that deliver high-quality health care and improve health system performance.
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CMS Innovations
http://innovation.cms.gov
We accept comments in the spirit of our comment policy: http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
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The webinar introduced the Comprehensive Primary Care initiative to the primary care provider community and covered the service delivery model, including the 5 Comprehensive Primary Care functions, and the milestones participating practices will need to achieve in the first year. The process for applying was also discussed, including information about the application itself.
More at: http://innovations.cms.gov/resources/CPCi-Webinar-for-PCPs.html
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
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The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents is an initiative designed to improve care for people living in nursing facilities who are enrolled in Medicare and Medicaid.
Through this initiative, CMS will partner with independent organizations to improve care for long-stay nursing facility residents. These organizations will collaborate with nursing facilities and States to provide coordinated, person-centered care with the goal of reducing avoidable hospital stays.
In this webinar, staff from the Medicare-Medicaid Coordination Office (MMCO) and the CMS Innovation Center will provide an overview of the initiative, and offer information about how to apply.
More at: http://innovations.cms.gov/resources/Duals_rahnfr_apply.html
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CMS Innovation
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
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CMS Privacy Policy
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CMMI, in partnership with Million Hearts® at the Centers for Disease Control and Prevention (CDC), will sponsor a webinar entitled Value-Based Insurance Design, Opportunities to Improve Medication Adherence for Cardiovascular Disease Prevention on October 21, 2021 from 3:00-4:00 PM ET. The webinar will present evidence-based high impact strategies for MAOs to improve care and outcomes for beneficiaries with cardiovascular disease (CVD), including underserved populations.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
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The CMS Innovation Center held the second in a series of webinars for potential applicants to Health Care Innovation Awards Round Two. The webinar held Wednesday, June 12, 2013 1:30pm – 3:00pm EDT, focused specifically on the first two of the four innovation categories.
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CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
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The CMS Innovation Center held the sixth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, July 11, 2013 from 1:00–2:00pm EDT, focused on developing payment models.
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CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Staff from the CMS Innovation Center and the Center for Medicare and CHIP Services hosted a webinar that provided an overview of the Strong Start initiative and the application process and requirements for the Medicaid funding opportunity.
More at: http://innovations.cms.gov/resources/StrongStart_overview.html
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Tuesday, June 10, 2014 from 12:00pm - 1:00pm EDT that focused on all components of the Round Two Model Test Award opportunity. The webinar also highlighted the requirements for submitting an application as well as considerations regarding the application review process.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The State Innovation Models initiative is a competitive funding opportunity for states to design and test multi-payer payment and service delivery models that deliver high-quality health care and improve health system performance.
- - -
CMS Innovations
http://innovation.cms.gov
We accept comments in the spirit of our comment policy: http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The webinar introduced the Comprehensive Primary Care initiative to the primary care provider community and covered the service delivery model, including the 5 Comprehensive Primary Care functions, and the milestones participating practices will need to achieve in the first year. The process for applying was also discussed, including information about the application itself.
More at: http://innovations.cms.gov/resources/CPCi-Webinar-for-PCPs.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents is an initiative designed to improve care for people living in nursing facilities who are enrolled in Medicare and Medicaid.
Through this initiative, CMS will partner with independent organizations to improve care for long-stay nursing facility residents. These organizations will collaborate with nursing facilities and States to provide coordinated, person-centered care with the goal of reducing avoidable hospital stays.
In this webinar, staff from the Medicare-Medicaid Coordination Office (MMCO) and the CMS Innovation Center will provide an overview of the initiative, and offer information about how to apply.
More at: http://innovations.cms.gov/resources/Duals_rahnfr_apply.html
- - -
CMS Innovation
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CMMI, in partnership with Million Hearts® at the Centers for Disease Control and Prevention (CDC), will sponsor a webinar entitled Value-Based Insurance Design, Opportunities to Improve Medication Adherence for Cardiovascular Disease Prevention on October 21, 2021 from 3:00-4:00 PM ET. The webinar will present evidence-based high impact strategies for MAOs to improve care and outcomes for beneficiaries with cardiovascular disease (CVD), including underserved populations.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the second in a series of webinars for potential applicants to Health Care Innovation Awards Round Two. The webinar held Wednesday, June 12, 2013 1:30pm – 3:00pm EDT, focused specifically on the first two of the four innovation categories.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the sixth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, July 11, 2013 from 1:00–2:00pm EDT, focused on developing payment models.
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CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center offered a kickoff webinar event for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Tuesday, May 31, 2016 from 4:00–5 p.m. EDT. This webinar focused on model objectives, terms of the award, eligibility criteria, changes from the first public solicitation and important deadlines. A 20 minute question and answer period followed the presentation.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted a repeat of the first open door forum in a series focusing on various aspects of the Model.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Next Generation ACO Model team hosted an open door forum on Tuesday, March 28, 2017. The Next Generation Model features three payment rule waivers, referred to as benefit enhancements. This open door forum provided an overview of the Model’s three benefit enhancements.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare Diabetes Prevention Program (MDPP) Model Expansion Medicare Learning Network (MLN) Call was held from 1:30 p.m. – 3:00 p.m. EST on November 30, 2016. During this call, CMS experts provided a high-level overview of the finalized policies in the CY 2017 Medicare Physician Fee Schedule (PFS) final rule (the CY 2017 Medicare PFS final rule includes the expansion of the MDPP Model beginning January 1, 2018), reviewed the steps necessary for enrollment into Medicare as an MDDPP supplier, and answered some of the audiences most pressing questions.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Monday, March 3, 2014 to provide information on how to calculate budget neutrality for the five prongs in the Frontier Community Health Integration Project Demonstration. CMS also provided examples of ways that applicants can respond to the solicitation. Subject matter experts from the CMS Innovation Center and the Health Resources Services Administration (HRSA) provided details and answered questions.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
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February 9, 2012
These slides are designed for Post-Acute Care (PAC) providers seeking additional information about how Model 3 works and a better understanding of the opportunities for PAC providers within the Bundled Payment for Care Improvement (BPCI) initiative to achieve better care, better health and lower costs for their patients through care redesign.
More at: http://innovations.cms.gov/resources/Bundled-Payments-Model-3-Deep-Dive.html
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Kidney Care Choices (KCC) Model team hosted a Comprehensive Kidney Care First (KCF) Model Option introduction webinar on Friday, November 15, 2019 from 12:00 p.m. - 1:00 p.m. EST.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this Thursday, July 12, 2012 webinar, presentations focused on learning more about program requirements, preferences, and other keys to success from CMS Innovation Center staff and communities currently participating in the CCTP program. The final CCTP review panel for 2012 convened on September 20, 2012. Applications must have been received by September 3rd to be considered for this review. Future panels may be announced as funding permits.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Oncology Care Model team hosted a webinar on OCM Frequently Asked Questions and Application Overview on Wednesday, April 22, 2015 at 12:00pm EDT. No password was required for the webinar.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CMS Innovation Center, Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can work with States and the role of States in the Strong Start funding opportunity. A series of follow up webinars will provide more in-depth information about other aspects of this initiative.
More at: http://innovations.cms.gov/resources/Strong-Start-Webinar-State-Partnerships.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a Beneficiary Engagement and Incentives: Direct Decision Support (DDS) Model webinar regarding the model overview and Letter of Intent (LOI) process on Thursday, January 12, 2017 from 2:00 - 3:00 p.m. EST. At this event, attendees learned more about the DDS model, eligibility criteria, and LOI requirements.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted an introduction webinar about the Oncology Care Model (OCM) on Thursday, February 19, 2015 from 12:00pm – 1:00pm EST. The webinar focused on introducing core concepts of OCM and application instructions. Advance registration was not required.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
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The Next Generation ACO Model team hosted an open door forum on Tuesday, February 28, 2017. During this open door forum Model team members provided a deep dive presentation examining details of financial aspects relating to the model.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this July 26, 2012 webinar, CMS Innovation Center staff provided an overview of the State Innovation Models Initiative.
More information can be found at: http://innovations.cms.gov/initiatives/state-innovations/index.html.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
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Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Thursday, April 21, 2016. During this webinar Model team members provided an overview of the model specifically for health IT vendors.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
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The CMS Innovation Center held a Medicare Advantage Value-Based Insurance Design Model webinar on August 24, 2016 from 2:00 – 3:00p.m. EDT. This webinar provided an overview of the changes to the model scheduled to take effect in 2018.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
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CMS Privacy Policy
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As part of a broader partnership, CMMI, the Office of the Assistant Secretary for Health (OASH) and the Administration for Community Living (ACL) are jointly sponsoring a webinar titled, Unleashing the Capabilities of MAOs to Deliver Health Innovation for Older Adults in Underserved Settings on October 7 from 2:30-4:00 PM ET to highlight the emerging, numerous opportunities for MAOs to support beneficiaries in more fully meeting their care needs and goals through novel approaches and services enabled by technology.
The webinar will provide an overview of the data supporting these opportunities and will include a panel of three speakers from payer organizations, each of whom will provide an overview of their experience and results in innovating in the use of technology to address unmet enrollee health needs. Panelists include Mona Siddiqui MD, MPH, Senior Vice President for Enterprise Clinical Strategy and Quality at Humana, who will discuss Humana’s approach to the use of data and predictive modeling to proactively engage and provide care for the highest risk and most vulnerable populations; John Wiecha, Medical Director, Senior Products Division at Point32Health, representing the newly combined organizations of Harvard Pilgrim Health Care and Tufts Health Plan will provide an overview of a recent pilot project to improve dementia care through a digital caregiver support program; and Caesar A. DeLeo, MD, MHSA Vice President & Executive Medical Director Strategic Initiatives, Highmark Health Enterprise Clinical Organization, Highmark BCBS who will discuss Highmark’s experience with telemedicine to approach substance use disorders during the pandemic and results from a five-year data driven program addressing appropriate opiate prescribing through profiling and academic detailing.
The webinar offers attendees the opportunity to gain a better understanding of the evidence and potential of several technology-enabled services in improving access, quality and outcomes of care, including, importantly, for underserved populations and will provide MAOs with insights more broadly on the challenges and solutions in design, implementation and evaluation of innovative and technology-enabled service. MAOs that are considering such innovations who may wish to target the use of technology-enabled and/or other services based on chronic illness and/or Low-Income Subsidy (LIS) status through the VBID Model are encouraged to attend.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
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This open door forum held on Tuesday, April 25, 2017 provided more detailed information on how to complete the Participant List tool for submission with your application to the Next Generation ACO Model.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Wednesday April 9, 2014 to provide an overview of the Medicare Care Choices Model and the application process. Subject matter experts from the CMS Innovation Center provided details and answered questions.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Wednesday, July 2, 2014, from 4:15pm-5:15pm EDT. The webinar reviewed Model Test Proposal Format Requirements, the ‘Population Health Plan’ Portion of the Model Test Project Narrative, and the Population Health Plan Deliverable of the Model Test Project Period.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model proposals on Wednesday, August 31, 2016, from noon – 1:00 p.m. EDT.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted the first of two webinars on November 19 to describe the final rule and respond to questions about the Comprehensive Care for Joint Replacement Model.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center offered a kickoff webinar event for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Tuesday, May 31, 2016 from 4:00–5 p.m. EDT. This webinar focused on model objectives, terms of the award, eligibility criteria, changes from the first public solicitation and important deadlines. A 20 minute question and answer period followed the presentation.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted a repeat of the first open door forum in a series focusing on various aspects of the Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Next Generation ACO Model team hosted an open door forum on Tuesday, March 28, 2017. The Next Generation Model features three payment rule waivers, referred to as benefit enhancements. This open door forum provided an overview of the Model’s three benefit enhancements.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare Diabetes Prevention Program (MDPP) Model Expansion Medicare Learning Network (MLN) Call was held from 1:30 p.m. – 3:00 p.m. EST on November 30, 2016. During this call, CMS experts provided a high-level overview of the finalized policies in the CY 2017 Medicare Physician Fee Schedule (PFS) final rule (the CY 2017 Medicare PFS final rule includes the expansion of the MDPP Model beginning January 1, 2018), reviewed the steps necessary for enrollment into Medicare as an MDDPP supplier, and answered some of the audiences most pressing questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Monday, March 3, 2014 to provide information on how to calculate budget neutrality for the five prongs in the Frontier Community Health Integration Project Demonstration. CMS also provided examples of ways that applicants can respond to the solicitation. Subject matter experts from the CMS Innovation Center and the Health Resources Services Administration (HRSA) provided details and answered questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
February 9, 2012
These slides are designed for Post-Acute Care (PAC) providers seeking additional information about how Model 3 works and a better understanding of the opportunities for PAC providers within the Bundled Payment for Care Improvement (BPCI) initiative to achieve better care, better health and lower costs for their patients through care redesign.
More at: http://innovations.cms.gov/resources/Bundled-Payments-Model-3-Deep-Dive.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Kidney Care Choices (KCC) Model team hosted a Comprehensive Kidney Care First (KCF) Model Option introduction webinar on Friday, November 15, 2019 from 12:00 p.m. - 1:00 p.m. EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this Thursday, July 12, 2012 webinar, presentations focused on learning more about program requirements, preferences, and other keys to success from CMS Innovation Center staff and communities currently participating in the CCTP program. The final CCTP review panel for 2012 convened on September 20, 2012. Applications must have been received by September 3rd to be considered for this review. Future panels may be announced as funding permits.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Oncology Care Model team hosted a webinar on OCM Frequently Asked Questions and Application Overview on Wednesday, April 22, 2015 at 12:00pm EDT. No password was required for the webinar.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CMS Innovation Center, Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can work with States and the role of States in the Strong Start funding opportunity. A series of follow up webinars will provide more in-depth information about other aspects of this initiative.
More at: http://innovations.cms.gov/resources/Strong-Start-Webinar-State-Partnerships.html
- - -
CMS Innovation Center
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The CMS Innovation Center hosted a Beneficiary Engagement and Incentives: Direct Decision Support (DDS) Model webinar regarding the model overview and Letter of Intent (LOI) process on Thursday, January 12, 2017 from 2:00 - 3:00 p.m. EST. At this event, attendees learned more about the DDS model, eligibility criteria, and LOI requirements.
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The Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted an introduction webinar about the Oncology Care Model (OCM) on Thursday, February 19, 2015 from 12:00pm – 1:00pm EST. The webinar focused on introducing core concepts of OCM and application instructions. Advance registration was not required.
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The Next Generation ACO Model team hosted an open door forum on Tuesday, February 28, 2017. During this open door forum Model team members provided a deep dive presentation examining details of financial aspects relating to the model.
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In this July 26, 2012 webinar, CMS Innovation Center staff provided an overview of the State Innovation Models Initiative.
More information can be found at: http://innovations.cms.gov/initiatives/state-innovations/index.html.
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Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Thursday, April 21, 2016. During this webinar Model team members provided an overview of the model specifically for health IT vendors.
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The CMS Innovation Center held a Medicare Advantage Value-Based Insurance Design Model webinar on August 24, 2016 from 2:00 – 3:00p.m. EDT. This webinar provided an overview of the changes to the model scheduled to take effect in 2018.
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As part of a broader partnership, CMMI, the Office of the Assistant Secretary for Health (OASH) and the Administration for Community Living (ACL) are jointly sponsoring a webinar titled, Unleashing the Capabilities of MAOs to Deliver Health Innovation for Older Adults in Underserved Settings on October 7 from 2:30-4:00 PM ET to highlight the emerging, numerous opportunities for MAOs to support beneficiaries in more fully meeting their care needs and goals through novel approaches and services enabled by technology.
The webinar will provide an overview of the data supporting these opportunities and will include a panel of three speakers from payer organizations, each of whom will provide an overview of their experience and results in innovating in the use of technology to address unmet enrollee health needs. Panelists include Mona Siddiqui MD, MPH, Senior Vice President for Enterprise Clinical Strategy and Quality at Humana, who will discuss Humana’s approach to the use of data and predictive modeling to proactively engage and provide care for the highest risk and most vulnerable populations; John Wiecha, Medical Director, Senior Products Division at Point32Health, representing the newly combined organizations of Harvard Pilgrim Health Care and Tufts Health Plan will provide an overview of a recent pilot project to improve dementia care through a digital caregiver support program; and Caesar A. DeLeo, MD, MHSA Vice President & Executive Medical Director Strategic Initiatives, Highmark Health Enterprise Clinical Organization, Highmark BCBS who will discuss Highmark’s experience with telemedicine to approach substance use disorders during the pandemic and results from a five-year data driven program addressing appropriate opiate prescribing through profiling and academic detailing.
The webinar offers attendees the opportunity to gain a better understanding of the evidence and potential of several technology-enabled services in improving access, quality and outcomes of care, including, importantly, for underserved populations and will provide MAOs with insights more broadly on the challenges and solutions in design, implementation and evaluation of innovative and technology-enabled service. MAOs that are considering such innovations who may wish to target the use of technology-enabled and/or other services based on chronic illness and/or Low-Income Subsidy (LIS) status through the VBID Model are encouraged to attend.
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This open door forum held on Tuesday, April 25, 2017 provided more detailed information on how to complete the Participant List tool for submission with your application to the Next Generation ACO Model.
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The CMS Innovation Center hosted a webinar on Wednesday April 9, 2014 to provide an overview of the Medicare Care Choices Model and the application process. Subject matter experts from the CMS Innovation Center provided details and answered questions.
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The CMS Innovation Center hosted a webinar on Wednesday, July 2, 2014, from 4:15pm-5:15pm EDT. The webinar reviewed Model Test Proposal Format Requirements, the ‘Population Health Plan’ Portion of the Model Test Project Narrative, and the Population Health Plan Deliverable of the Model Test Project Period.
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The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model proposals on Wednesday, August 31, 2016, from noon – 1:00 p.m. EDT.
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The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted the first of two webinars on November 19 to describe the final rule and respond to questions about the Comprehensive Care for Joint Replacement Model.
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The CMS Innovation Center held a Comprehensive Care for Joint Replacement Model webinar on proposed rule changes to the model on September 7, 2016.
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The Next Generation ACO Model team hosted an open door forum on Tuesday, January 31, 2017. During this open door forum Model team members provided an overview of the Model, along with information pertaining to the Letter of Intent (LOI).
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The CMS Innovation Center hosted an informational webinar March 11, 2014 on the parameters of Models 2-4 of the Bundled Payments for Care Improvement Initiative. This webinar was geared towards physicians, specialty practices and physician group practices.
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The Beneficiary Engagement and Incentives: Direct Decision Support (DDS) Model team hosted a webinar on Thursday, February 9, 2017. During this webinar Model team members provided an overview of the application, application sections, cost worksheet and provided technical guidance followed by a question-and-answer (Q&A) segment.
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The CMS Innovation Center hosted a webinar on Tuesday, March 4, 2014 to discuss the Winter Open Period. This webinar included available information about the models, as well as the process and requirements for submitting requests for participation.
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Implementing Bundled Payments: A Deeper DiveWellbe
A Bundled Payment can be defined as “a single package price that provides a positive margin for a comprehensive and specific set of healthcare services delivered by multiple providers over a specified period of time.”
There is growing consensus that this payment methodology, and the powerful spillover effect from extensive care redesign associated with its implementation, may be the most effective strategy to reduce spiraling healthcare costs.
The secondary hypothesis is that bundled payment creates sufficient financial incentives to encourage multiple stakeholders to re-align and focus on improving the value of healthcare delivered to the patient.
There is data, including from the Connecticut Joint Replacement Institute (CJRI), which supports these hypotheses. Despite growing interest in bundled payment methodology, however, there are numerous upside challenges and downside risks. In this webinar, these issues will be reviewed and a cogent strategy for implementing a bundled payment program presented.
About the Speaker:
Dr. Steven F. Schutzer graduated with Honors from Union College 1974 and then the University of Virginia School Of Medicine in 1978. Dr. Schutzer was a Lieutenant in the Medical Corps of the United States Navy between 1979 and 1981. He did his General Surgical training at the University of Rochester and then completed his Orthopedic Residency at the University of Connecticut in 1985. He was then a Fellow in Adult Hip and Reconstructive Surgery at the Massachusetts General Hospital and entered practice with Orthopedic Associates of Hartford in July 1986.
He is currently on the staff of St. Francis Hospital, Hartford Hospital and the University of Connecticut John Dempsey Hospital. Dr. Schutzer is a Founding Member and the Medical Director of the Connecticut Joint Replacement Institute. He is also President of Connecticut Joint Replacement Surgeons, LLC. Dr. Schutzer is a member of AAOS, AAHKS, and the Orthopedic Research Society.
Advisor Live: Proposed Episode Payment Models for AMI, CABG, and Hip and Femu...Premier Inc.
On July 25, 2016, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to establish three new bundled payment policies for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) and surgical hip and femur fracture treatment (SHFFT). Collectively, the models are referred to as Episode Payment Models (EPMs). The new payment models will be mandatory for hospitals in particular geographic regions.
CMS proposes to test the EPM models for a five-year performance period, beginning July 1, 2017, and ending Dec. 31, 2021. The proposed rule also includes changes to the Comprehensive Care for Joint Replacement Model and proposes to establish an incentive payment to hospitals for coordinating cardiac rehabilitation and intensive cardiac rehabilitation services. CMS is accepting comments on the proposed rule until Oct. 3, 2016.
This webinar provides an overview of the proposed rule, including:
- Background and rationale for new payment models,
- Inclusion and exclusion criteria,
- Payment methodology,
- Quality performance in the payment methodology, and
- Legal waivers.
You know cost modeling is important. But are you getting it done? This presentation is your little nudge towards putting together your hospital cost model that is CJR ready.
Prof Devlin discusses the rationale for the PROMs programme and provides an overview of the various uses of the EQ-5D in England—for example by NICE in health technology assessment, in population surveys and in the English NHS PROMS program. The presentation also reviews how EQ-5D data are collected, analysed and used in the UK to inform decisions by health care providers, payers and patients.
As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
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This Accountable Health Communities Model webinar was held on Wednesday, February 10, 2016 from 3:00 – 4:00pm EST. The webinar focused on the anticipated role of state Medicaid agencies in the model.
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Presentation on payment reform and changing models given at 2016 Ziegler National Senior Living CFO Workshop, April 6-8, 2016 at The Sheraton New Orleans Hotel.
this is a ppt on histotechniques,, all techniques from receiving samples to block making to sectioning to staining are discusses in detail..useful for postgraduate pathology students and lab technicians
Massimo Sarmi: 5 maggio Poste festeggia i 150 anniPosteItaliane
Poste Italiane, guidata dall’AD Massimo Sarmi, compie 150 anni, una festa condivisa con tutti gli italiani. Il 5 maggio 1862 la Legge n. 604 di Riforma postale istituiva il servizio nazionale. Lo storico anniversario sarà celebrato con la mostra “150 anni dedicati al futuro”: cupole hi-tech al Circo Massimo per raccontare in chiave multimediale il lungo percorso dell’azienda. L’area espositiva sarà inaugurata l’8 maggio dal Presidente della Repubblica, Giorgio Napolitano.
Chronic Care Management Coding Guidelines Effective January 1, 2017Manny Oliverez
The Centers for Medicare and Medicaid Services (CMS) recently released new billing requirements for chronic care management services. CMS initiated these latest billing changes in order to improve payment accuracy for CCM services as well as reduce the administrative burden for providers.
Visit Our Website: http://www.CaptureBilling.com/
Modern Relationships Between Physicians, Hospitals, and Long-Term Care Provid...PYA, P.C.
PYA Consulting Manager Aaron Elias co-presented “Modern Relationships Between Physicians, Hospitals, and Long-Term Care Providers in a Time of Risk-Based Contracting,” along with Jeanna Palmer Gunville, a shareholder at Polsinelli.
The Center for Medicare and Medicaid Innovation hosted a series of two webinars on Wednesday, July 15 and Thursday, July 16, 2015. These webinars focused on providing an overview of the model and provided an opportunity for attendees to ask questions.
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The 2020 Hospital Outpatient Prospective Payment System (OPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement.
As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2020 OPPS Final Rule to quickly give you insight into the most important changes.
BESLER remains your trusted advisor and we look forward to helping you identify areas of revenue opportunity for your facility.
The Center for Medicare & Medicaid Innovation hosted an Open Door Forum (ODF) to allow dialysis facilities, nephrologists, other Medicare providers of services, suppliers, and other interested parties to ask questions on the revisions to the Request for Application (RFA) for the Comprehensive End Stage Renal Disease (ESRD) Care Initiative that was released on April 15, 2014.
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The Community Health Access and Rural Transformation (CHART) Model team hosted an overview webinar on Tuesday, August 18, 2020 from 1:00 - 2:30 PM EDT. Attendees had the opportunity to hear an overview of the CHART Model, including its objectives, eligible participants and their roles, payment options, and timeline.
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NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
Why You Need to Understand Value-Based Reimbursement and How to Survive ItHealth Catalyst
There are clear signs the healthcare industry is in the midst of a shift to value-based reimbursement. The most noticeable signs are the recent and proposed 2015 rulings from CMS. There are four areas in value-based reimbursement that will be impacted by the end of 2015: the physician payment structure, bundled payments, Inpatient Prospective Payment Systems regulations, and commercial payers. To survive the shift to value-based reimbursement, it’s important for providers and payers to take three steps: provide access to rich data, share knowledge and learn from each other, develop strategies by doing assessments.
Delivering Care Under the MACRA Final Rule: Implementation Considerations and...Epstein Becker Green
Presented November 18, 2016, by Mark Lutes, Robert F. Atlas, and Lesley R. Yeung of Epstein Becker Green and EBG Advisors.
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Guide to CMS Comprehensive Care for Joint Replacement modelQ-Centrix
On April 1, the CMS Comprehensive Care for Joint Replacement (CCJR) model went into effect for nearly 800 hospitals in 67 markets nationwide. Essentially, CMS converted its voluntary payment model—Bundled Payment for Care Improvement (BPCI)—into a regulatory mandate that will hold hospitals accountable for spending by all healthcare providers for 90 days following the initial episode of care.
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
This episode continues our COVID-19 COVID-19 Insights Webinar discussing CMS changes, available grants and loans, existing opportunities in telehealth, and more state openings for elective surgeries.
Published January, 2017 - First Illinois Speaks
Author: Maria C. Miranda, FACHE, Director, Emerging Payment Models
Introduction: While the Comprehensive Care for Joint Replacement (CJR) program is positioned as a “test,” given the infrastructure being put in place by the Centers for Medicare and Medicaid Services (CMS) to run the program, CJR is likely just the start of a larger effort by CMS to implement additional mandatory bundled payment programs. Therefore, it’s very important that hospital financial stakeholders become familiar with CJR even if their hospital isn’t currently a participant.
Similar to Webinar: Advancing Care Coordination through Episode Payment Models (EPMs) - Introduction (20)
The Medicare Advantage Value-Based Insurance Design (VBID) Model team at the Center for Medicare and Medicaid Innovation (CMMI) and national leaders participated in a discussion around pathways for addressing food and nutritional insecurity at webinar event of our Health Equity Incubation Program on Thursday, March 31, 2022, from 3:00-4:30 PM ET.
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The CMS Innovation Center hosted an office hours session on Tuesday, April 5, 2022 from 3:00-4:00 PM ET to discuss the Medicare Advantage Value-Based Insurance Design (VBID) Model and its Hospice Benefit Component. Attendees received an overview of the Model and the CY 2023 application process, and had an opportunity for questions and answers with the Model team.
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The ACO REACH Model Team will hosted a health equity webinar on Tuesday, April 5, 2022 from 4:00 - 5:00 p.m. EDT. The ACO REACH Model team highlighted Health Equity provisions added to the ACO REACH Model.
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This webinar focuses on the new financial policies featured in the ACO REACH webinar. For more information on the financial methodology for the ACO REACH Model that will be transitioned from the Global and Professional Direct Contracting (GPDC) Model, please refer to prior released financial webinars available on the GPDC Model webpage.
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During this webinar, a high-level overview of the ACO REACH Model was provided including information on the participation and eligibility requirements, Accountable Care Organization (ACO) types, payment mechanisms, and beneficiary alignment methodology.
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The CMS Innovation Center will host a webinar on Thursday, March 10, 2022 from 3:00-4:00 PM ET. During this webinar, presenters will provide a brief review of the recently released Calendar Year (CY) 2023 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component as well as the payment design related to the Hospice Benefit Component of the VBID Model. This session will also offer attendees an opportunity to ask follow-up questions.
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This webinar provided an overview of the Model and the Part D Sponsor application process, as well as included a Q&A session for interested Part D sponsors.
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The CMS Innovation Center hosted a webinar on Wednesday, March 2, 2022 at 3pm – 4pm ET, during which presenters shared updates on the Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model, the Kidney Care Choices (KCC) Model, and the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. This event was available to the first 1,000 registrants. Presentation materials will be available on the respective model webpages following the session.
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The Medicare Advantage Value-Based Insurance Design (VBID) Model Team hosted an office hours session on Thursday February 3rd, 2022 on the Hospice Benefit Component to provide technical and operational support to interested stakeholders. During this office hours session, presenters answered questions submitted in advance to the VBID Mailbox and offered attendees an opportunity to ask additional questions.
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Has your organization prioritized addressing health inequities? How can a Center for Medicare and Medicaid Innovation (CMMI) Model factor into your organization’s health equity strategy? How can you structure your plan’s benefits to have the greatest impact on underserved communities? What partnership opportunities are available with CMMI?
These are important questions CMMI plans to answer in a new webinar series focused on health equity! CMMI is sponsoring a series of webinars for current and potential Medicare Advantage Organization (MAO) participants in the Value-Based Insurance Design (VBID) Model.
The first webinar in the series provided an overview of the Model’s Health Equity Incubation Sessions effort, articulated a business case for MAOs to leverage VBID Model Components to address health inequities in their member populations, and provided specific guidance and clarification on the full extent of health equity focused flexibilities that fall under the Model’s waiver authority.
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The ET3 Model and Medicaid: Opportunities for Alignment webinar provided background on the ET3 Model, discussed the benefits for states of aligning coverage and payment policies with ET3, and explored considerations for states seeking to implement new Medicaid services that align with the ET3 Model. This webinar was intended for state Medicaid agencies, ET3 Model Participants, and other stakeholders interested in learning more about optional Medicaid alignment with the ET3 Model.
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CMS announced an Office Hour event for potential applicants to ask questions ahead of the PCF application deadline.
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You may also refer to the materials from the two PCF webinars held in March: Introduction to PCF and Ready, Set, Apply.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In order to help ETC Model Participants prepare for the ETC Model, CMS conducted an introductory webinar on Wednesday, December 9, 2020 from 1 p.m. to 2 p.m. The webinar provided an overview of the ETC Model, including:
Participant selection
The Home Dialysis Payment Adjustment
The Performance Payment Adjustment
The ETC Model timeline, including the timing of payment adjustments
Information about how to communicate with CMS about the ETC Model
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Value-Based Insurance Design (VBID) Model team hosted a webinar on January 28, 2021 from 4:00-5:00 PM EST. During this webinar, presenters provided a brief review of the recently released Calendar Year (CY) 2022 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component. This session also offered attendees an opportunity to ask follow-up questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Wednesday, March 17, 2021 from 4:00 - 5:00 PM EDT. During this webinar, presenters provided a preview of the Calendar Year 2022 payment design related to the Hospice Benefit Component of the VBID Model. The session also offered attendees an opportunity to ask follow-up questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Part D Senior Savings Model and Part D Payment Modernization Model teams hosted a webinar on Tuesday, March 23, 2021 from 1:00 to 2:00 PM EDT. During this webinar, presenters provided an overview of the two Models and the Calendar Year (CY) 2022 application process. The session also offered attendees an opportunity to ask follow-up questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CMS hosted a virtual office hour session on April 13, 2021 from 4:00-5:00 PM EDT. During this office hour, presenters provided a review of the Calendar Year 2022 payment design and payment rates related to the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model. This session also offered attendees an opportunity to ask follow-up questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Emergency Triage, Treat, and Transport (ET3) Model Medical Triage Line Notice of Funding Opportunity (NOFO) webinar provided an overview of the application process and NOFO requirements for implementing 911 medical triage lines. This webinar was intended for those interested in learning more about the ET3 Model’s Notice of Funding Opportunity, which was released March 12.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Primary Care First Model (PCF) Options team provided an overview of the PCF payer partnership. Participants were able to learn about current PCF Model participants, benefits to payer partnership, the framework against which payer proposal alignment will be evaluated, and the payer solicitation process and timeline.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Primary Care First Model Options team provided an overview of the Model, including goals, eligibility to participate in the second cohort, payment design and attribution, and data sharing. Model staff answered your questions about these topics.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
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Webinar: Advancing Care Coordination through Episode Payment Models (EPMs) - Introduction
1. Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and
Changes to the Comprehensive Care for Joint Replacement Model (CJR): Final Rule Overview
February 22, 2017
3. Disclaimer
• This presentation was current at the time it was published or uploaded onto the web. Medicare policy
changes frequently, so links to the source documents have been provided within the document for
your reference.
• This presentation was prepared as a service to the public and is not intended to grant rights or impose
obligations. This presentation may contain references or links to statutes, regulations, or other policy
materials. The information provided is only intended to be a general summary. It is not intended to
take the place of either the written law or regulations. We encourage readers to review the specific
statutes, regulations, and other interpretive materials for a full and accurate statement of their
contents.
3
4. Today’s Agenda
Request for hospital point of contact (POC) information
Please send the following information to epmsupport@cms.hhs.gov
• Hospital CCN in Subject Line
• Names of two primary points of contact for EPM communication
• Titles, telephone numbers, and email addresses for POCs
• Hospital Physical Mailing Address
Highlight major policy changes in final rule compared to proposed rule
Overview of Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Rehabilitation
Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR) final rule
Slides will be available on our website https://innovation.cms.gov/initiatives/epm/ as soon as possible.
4
5. The proposed rule was published on August 2, 2016, with the comment period ending October 3, 2016. After
reviewing nearly 175 highly detailed comment submissions from the public on the proposed rule, and considering
commenters’ thoughtful perspectives, several major changes were made from the proposed rule.
On December 20, 2016, the final rule entitled: Advancing Care Coordination Through Episode Payment Models (EPMs);
Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement
Model (CJR) went on display at the Federal Register. As directed by the White House memorandum of January 20,
2017 entitled “Regulatory Freeze Pending Review”, CMS is delaying the effective date of the provisions of the final
rule, which were to become effective on February 18, until March 21. The delay notice was published in the Federal
Register on February 15, 2017. No other changes to the rule beyond the effective date delay are anticipated at this
time.
The full text of the rule is available now online and in PDF format at the following website:
– https://www.federalregister.gov/documents/2017/01/03/2016-
30746/medicare-program-advancing-care-coordination-through-episode-
payment-models-epms-cardiac.
5
Proposed Rule to Final Rule
6. EPM Final Rule Summary
The Advancing Care Coordination Final rule implements three new Medicare Parts A and B episode payment models,
in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for
episodes of care for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) and surgical hip and femur
fracture treatment (SHFFT). The rule also implements a Cardiac Rehabilitation (CR) Incentive Payment model and
makes modifications to the existing Comprehensive Care for Joint Replacement (CJR) model under section 1115A of
the Social Security Act.
The new CR Incentive Payment model will test incentive payments to increase utilization of CR services for AMI and
CABG patients, both alongside the AMI and CABG EPMs as well as in conjunction with traditional fee for service (FFS)
Medicare payments.
The CJR model changes will clarify, modify and update certain provisions around target pricing, composite quality, and
beneficiary incentives and exclusions. Additionally the final rule creates an option for CJR participant hospitals to be in
an Advanced APM that would, in turn, allow eligible clinicians to be considered for a QP determination.
6
7. In response to comments received on the proposed rule, CMS made the following changes to
the final rule policies:
• Pricing and Payment
Downside risk will begin for all on October 1, 2018 instead of on April 1, 2018 which was the
proposed date; The models now allow voluntary opt in to downside risk Jan 1, 2018 (to meet
advanced APM requirements).
A low-volume provider definition was created in response to comment and hospitals in this
category will have the same lower stop-loss limits provided to rural hospitals in the model.
• Quality
Proposed quality measures were finalized with a modification to the proposed CABG
measures to include data submission for the STS composite CABG measure as a voluntary
measure worth 2 additional points toward the composite CABG quality score.
7
Major Policy Changes from the Proposed Rule
8. • Transfers:
We did not finalize the proposal for chained anchor hospitalization therefore the terms
‘chained anchor stay’ and ‘Price-DRG’ are not applicable for the final models. We now
cancel AMI episodes that begin on inpatient admission to the initial treating hospital
when any inpatient-to-inpatient transfer occurs.
A new AMI or CABG episode begins at the transfer hospital if that transfer hospital is an
AMI or CABG participant and the MS-DRG (and diagnosis) assigned at the transfer
hospital meets the criteria for initiating an AMI or CABG episode.
Begin episode and assign risk and clinical episode to final discharging hospital after any
transfer (either from the emergency department or inpatient hospitalization at the
initial treating hospital).
8
Major Policy Changes from the Proposed Rule
9. Better Care
• Better care for patients through more coordinated, higher quality care during and
after select episodes or care periods
Smarter Spending
• Smarter spending of health care dollars by holding hospitals accountable for total
episode spending, not just inpatient costs, and incentivizing use of high value services
during care periods
Healthier People and Communities
• Healthier people and communities by improving coordination in health care and by
connecting care across hospitals, physicians, and other health care providers
What Are the EPMs Designed To Do for
Patients and the Health System?
9
10. EPM Participants
AMI & CABG EPMs: Hospitals in 98 selected metropolitan statistical areas (MSAs), with limited
exceptions. The MSAs were randomly selected from 293 eligible MSAs and presented in the
final rule.
SHFFT EPM: Hospitals in MSAs selected for the CJR model, with limited exceptions.
Participant hospitals in these selected MSAs are all acute care hospitals paid under the IPPS
that are not currently participating in Models 1, 2 or 4 of the Bundled Payments for Care
Improvement (BPCI) Initiative.
Current estimate is that over 2,000 hospitals will participate in the EPMs and CR Incentive
Payment Model. Participant lists are available at the EPM website.
https://innovation.cms.gov/initiatives/epm/
10
11. Advanced APM Tracks
In order to maximize the opportunities for eligible clinicians to participate in Advanced APMs, CMS
finalized two tracks for each of the EPMs. Participants may switch between tracks during the 5 years the
models run.
Track 1 – Advanced APM Track
Participant hospitals must meet and attest to the CEHRT use requirement, as specified in section
1833(z)(3)(D)(i)(I) of the Act
Participants must submit a clinician financial arrangements list to CMS no more than quarterly
Participation of eligible clinicians collaborating with Track 1 hospitals will count toward Advanced
APM participation for purposes of the Quality Payment Program
Track 2 – Non Advanced APM Track
EPM participants that do not choose to meet and attest to the CEHRT use requirement will be in
Track 2
11
12. What is an EPM Episode of Care?
EPM episodes initiate with hospitalizations of eligible Medicare fee-for-service beneficiaries
discharged with specified MS-DRGs:
AMI (AMI MS-DRGs: 280-282 & PCI MS-DRGs: 246-251 with AMI ICD-CM diagnosis code)
IPPS admissions for AMI treated medically or with revascularization via percutaneous
coronary intervention (PCI)
CABG (MS-DRGs: 231-236)
IPPS admissions for surgical coronary revascularization irrespective of AMI diagnosis
SHFFT (MS-DRGs: 480-482)
IPPS admissions for hip/femur fracture fixation, other than joint replacement
Episodes include:
Hospitalization and 90 days post-discharge
The day of discharge is counted as the first day of the 90-day post-discharge period.
All Part A and Part B services, with the exception of certain excluded services that are clinically
unrelated to the episode
12
13. EPM Eligible Beneficiaries
Medicare beneficiaries are eligible for EPM episodes if Medicare is the primary payer
and the beneficiary is:
Enrolled in Medicare Part A and Part B throughout the duration of the
episode;
Not eligible for Medicare on the basis of End Stage Renal Disease;
Not enrolled in a managed care plan (e.g., Medicare Advantage, Health Care
Prepayment Plans, cost-based health maintenance organizations); and
Not covered under a United Mine Workers of America health plan.
If at any time during the episode the Medicare beneficiary no longer meets all of
these criteria aforementioned, the episode is canceled.
13
14. Included and Excluded EPM Episode Services
14
Included Services
• Physicians' services
• Inpatient hospitalization
• Inpatient hospital readmission
• Inpatient Psychiatric Facility (IPF)
• Long-term care hospital (LTCH)
• Inpatient rehabilitation facility (IRF)
• Skilled nursing facility (SNF)
• Home health agency (HHA)
• Hospital outpatient services
• Outpatient therapy
• Clinical laboratory
• Durable medical equipment (DME)
• Part B drugs and biologicals
• Hospice
• PBPM payments under models tested under section 1115A of the
Social Security Act
Excluded Services
• Acute clinical conditions not arising from existing
episode-related chronic clinical conditions or
complications.
• Chronic conditions that are generally not affected by the
episode.
• The list of excluded MS-DRGs and ICD-CM diagnosis codes,
including both ICD-9-CM and ICD-10-CM, is posted on the CMS
website.
• Potential modifications to the MS-DRGs and/or ICD-10-CM
exclusion lists will be posted to the CMS website in mid-
March. Public input will be considered and the final 2017
exclusion lists reflecting any changes from this code review
will be posted to the CMS website by mid-May.
15. Payment and Pricing: Risk Sharing
Retrospective, two-sided risk model with hospitals bearing financial responsibility
• Providers and suppliers continue to be paid via Medicare FFS
• After a performance year, actual episode spending will be compared to the episode target prices
If aggregate target prices are greater than actual episode spending, hospitals may receive a
reconciliation payment
If aggregate target prices are less than actual episode spending, hospitals will be
responsible for making a payment to Medicare
Responsibility for repaying Medicare can begin in Performance Year 2, for participants who elect
voluntary early downside risk. Otherwise, phased-in downside risk begins in Performance Year 3 for
all participants (i.e., for episodes that begin as of October 4, 2018).
15
16. Payment and Pricing: Target Prices
CMS will establish target prices for each participant hospital
Specific to MS-DRGs for each of the models
Risk stratification (e.g., CABG readmission in AMI episode)
Based on 3 years of historical data
Quality-adjusted target prices include an effective discount factor (based on quality
performance and improvement) to serve as Medicare’s savings
Based on blend of hospital-specific and regional episode data (US Census Division),
transitioning to regional pricing
• PerformanceYears1and2:2/3hospital-specific,1/3regional
• PerformanceYear3:1/3hospital-specific,2/3regional
• PerformanceYears4and5:100%regionalpricing
16
17. Payment and Pricing: Link to Quality through Pay-
for-Performance
Hospitals are assigned a composite quality score each year based on their
performance and improvement in model-specific quality measures and
data submission.
Voluntary data submission is weighted at 10% of composite quality
scores for each of the models.
More information on quality is available at the EPM website:
https://innovation.cms.gov/initiatives/epm
17
18. Payment and Pricing: Link to quality
through pay-for-performance
Downside Risk for All Participants– DR effective for episodes ending on or after 1/1/2019 (anchor discharges occurring on or after 10/4/2018)
No data PY1 PY2 PY3 PY4 PY5
Stop-loss threshold n/a as no
downside risk in
PY1 and PY2
without election of
voluntary
downside risk for
PY2
n/a as no
downside risk in
PY1 and PY2
without election
of voluntary
downside risk
for PY2
5% 10% 20%
Stop loss threshold for certain
hospitals*
n/a as no
downside risk in
PY1 and PY2
without election of
voluntary
downside risk for
PY2
n/a as no
downside risk in
PY1 and PY2
without election
of voluntary
downside risk
for PY2
3% 5% 5%
Discount percentage (range) for
Repayment, Depending on Quality
Category
n/a as no
downside risk in
PY1 and PY2
without election of
voluntary
downside risk for
PY2
n/a as no
downside risk in
PY1 and PY2
without election
of voluntary
downside risk
for PY2
0.5%-2.0% 0.5%-2.0% 1.5%-3.0%
*Including rural and sole-community hospitals, rural referral centers, Medicare Dependent Hospitals and hospitals determined to be EPM volume
protection hospitals within an EPM.
18
19. Payment and Pricing: Link to quality
through pay-for-performance (continued)
Voluntary Downside Risk – DR effective for episodes ending on or after 1/1/2018 (anchor discharges occurring on or after 10/4/2017)
No data PY1 PY2 PY3 PY4 PY5
Stop-loss threshold n/a as no
downside risk
in PY1
5% 5% 10% 20%
Stop loss threshold for certain
hospitals*
n/a as no
downside risk
in PY1
3% 3% 5% 5%
Discount percentage (range) for
Repayment, Depending on Quality
Category
n/a as no
downside risk
in PY1
0.5%-2.0% 0.5%-2.0% 0.5%-2.0% 1.5%-3.0%
*Including rural and sole-community hospitals, rural referral centers, Medicare Dependent Hospitals and hospitals determined to be EPM
volume protection hospitals within an EPM.
19
20. Payment and Pricing: Rural
Additional protection for rural, sole community (SCH), Medicare
dependent (MDH), rural referral center (RRC), and certain low-
volume hospitals with stop-loss of 3% for Performance Year 2 (if
voluntary downside risk elected), 3% for Performance Year 3 and
5% for Years 3 through 5.
These protections strike an appropriate balance between protecting
hospitals that often serve as the only access of care for Medicare
beneficiaries and having these hospitals meaningfully participate in
the model.
20
21. Overlap with BPCI
Hospital participation in BPCI vs. EPMs in selected MSAs
• Hospitals in BPCI Models 1, 2, or 4 for episodes that would otherwise qualify as EPMs (e.g., SHFFT,
AMI, CABG) may remain in BPCI and are not required to participate in the EPM model for those
episodes covered under BPCI.
• BPCI participants that terminate from a BPCI model for the equivalent EPM episode and are located
in an MSA that has been selected for that EPM are required to participate in the EPM model.
• Hospitals not already in BPCI may not elect to participate in BPCI in lieu of participation in the EPM
model.
• A hospital participating in BPCI for one type of episode (e.g., CABG) will still be required to
participate in unrelated EPMs (e.g., AMI or SHFFT) if it is located in a selected MSA and a
beneficiary would otherwise qualify for an EPM episode that is not covered under BPCI.
Instances where BPCI participation takes precedence over EPM when hospital is not
participating in BPCI:
• BPCI Model 2 or 3 PGP practicing at an EPM hospital when the EPM hospital is not a BPCI participant.
• BPCI Model 3 episode initiates when a patient is discharged from an EPM hospital to a BPCI Model 3
PAC provider.
21
22. Overlap with ACOs
Hospitals selected to participate in the EPM model may also participate in an
ACO or other models.
Beneficiaries prospectively aligned to ACOs with downside risk (e.g., NextGen
ACOs, MSSP Track 3 ACOs, or the Comprehensive ESRD Care Initiative) are
excluded from EPMs. The ACO will be accountable for those beneficiaries’
total cost of care.
Beneficiaries aligned with all other ACOs will be eligible to participate in
EPMs. Savings achieved during an EPM episode shall be attributed to the
EPM participant and EPM reconciliation payments for ACO-aligned
beneficiaries shall be considered ACO expenditures.
22
23. Overlap with Other Models
Per beneficiary per month (PBPM) payments for new and enhanced services
shall be included in EPM reconciliation calculations if CMS determines, on a
model by model basis, that the services paid for by the PBPM payments are:
• (1) not excluded from an EPM model's episode definition;
• (2) rendered during the episode; and
• (3) paid for from the Medicare Part A or Part B Trust Funds.
23
24. Financial Arrangements: Gainsharing
Consistent with applicable law and regulations, EPM participants may have certain financial
arrangements to share gains and losses with collaborators to support their efforts to improve
quality and reduce costs.
EPM Collaborator means an ACO or one of the following Medicare-enrolled individuals or entities
that enters into a sharing arrangement:
Skilled Nursing Facility (SNF)
Home Health Agency (HHA)
Long-term care hospital (LTCH)
Inpatient rehabilitation facility (IRF)
Physician
Non-physician practitioner
Therapist in private practice
Comprehensive outpatient rehabilitation facility (CORF)
Provider of outpatient therapy services
Physician Group Practice (PGP)
Hospital
Critical Access Hospital (CAH)
Non-physician Practitioner Group Practice ( NPPGP)
Therapy Group Practice (TGP)
24
25. Financial Arrangements: Gainsharing Payments
EPM participants may share with EPM collaborators:
Gainsharing payments in the form of reconciliation payments, or internal cost
savings, or both.
EPM collaborators (other than an ACO, PGP, NPPGP, or TGP) must have directly
furnished a billable item or service to an EPM beneficiary during an EPM episode
that occurred in the same performance year for which the EPM participant
accrued the internal cost savings or earned the reconciliation payment that
comprises the gainsharing payment or was assessed a repayment amount.
To be eligible to receive a gainsharing payment, or to be required to make an
alignment payment, an EPM collaborator that is an ACO, PGP, NPPGP, or TGP
must meet specific criteria such as:
• Contributing to EPM activities and being clinically involved in the care of EPM
beneficiaries.
25
26. Financial Arrangement: Alignment Payments
The EPM participant must not receive any amounts under a sharing arrangement
from an EPM collaborator that are not alignment payments.
For a performance year, the aggregate amount of all alignment payments received
by the EPM participant must not exceed 50% of the EPM participant's repayment
amount.
The aggregate amount of all alignment payments from an EPM collaborator to the
EPM participant may not be greater than—
• With respect to an EPM collaborator other than an ACO, 25% of the EPM
participant's repayment amount; or
• With respect to an EPM collaborator that is an ACO, 50% of the EPM
participant's repayment amount.
26
27. Financial Arrangements: Distribution Payments
Distribution arrangement means a financial arrangement between an EPM
collaborator that is an ACO, PGP, NPPGP, or TGP and a collaboration agent for the
sole purpose of distributing some or all of a gainsharing payment received by the
ACO, PGP, NPPGP, or TGP.
The EPM collaborator may not enter into a distribution arrangement with any
individual or entity that has a sharing arrangement with the same EPM participant.
Distribution payments must be substantially based on quality of care and the
provision EPM activities.
For PGPs, distribution payments must be determined either in a manner that
complies with § 411.352(g) of this chapter or must be substantially based on quality
of care and the provision EPM activities.
27
28. Financial Arrangements:
Downstream Distribution Arrangements
Downstream distribution arrangement means a financial arrangement between
a collaboration agent that is both a PGP, NPPGP, or TGP and an ACO participant
and a downstream collaboration agent for the sole purpose of distributing some
or all of a distribution payment received by the PGP, NPPGP, or TGP.
The total amount of all downstream distribution payments made to downstream
collaboration agents must not exceed the amount of the distribution payment
received by the PGP, NPPGP, or TGP from the ACO.
For PGPs, downstream distribution payments must be determined either in a
manner that complies with § 411.352(g) of this chapter or must be substantially
based on quality of care and the provision EPM activities.
Downstream Distribution Payments must be substantially based on quality of
care and the provision of EPM activities
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30. Financial Arrangements:
Beneficiary Incentives
EPM participants may choose to provide in-kind patient engagement incentives to
beneficiaries in an EPM episode, subject to the following conditions:
• The incentive must be provided directly by the EPM participant or by an agent of
the EPM participant under the EPM participant's direction and control to the EPM
beneficiary during an EPM episode.
• The item or service provided must be reasonably connected to medical care
provided to an EPM beneficiary during an EPM episode.
• The item or service must be a preventive care item or service or an item or service
that advances a clinical goal, as listed in § 512.525 (c), for a beneficiary in an EPM
episode by engaging the beneficiary in better managing his or her own health.
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31. Financial Arrangements:
Beneficiary Incentives
The item or service must not be tied to the receipt of items or services outside the
EPM episode.
The item or service must not be tied to the receipt of items or services from a
particular provider or supplier.
The availability of the items or services must not be advertised or promoted
except that a beneficiary may be made aware of the availability of the items or
services at the time the beneficiary could reasonably benefit from them.
The cost of the items or services must not be shifted to another federal health
care program, as defined at section 1128B(f) of the Act.
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32. Financial Arrangements and
Beneficiary Incentives Waivers
Some financial arrangements may implicate the federal fraud and
abuse laws.
The Secretary may consider whether waivers of certain fraud and
abuse laws are necessary to test the EPMs.
No waivers needed for arrangements that comply with existing
federal law.
Waivers, if any, would be promulgated separately by OIG and CMS.
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33. Program Rule Waivers: Telehealth
Only for services that may be furnished via telehealth under existing requirements and are included in an
EPM episode in accordance with § 512.210, CMS waives:
The geographic site requirement of section 1834(m)(4)(C)(i)(I) through (III) of the Act for episodes being
tested in an EPM (Except for the geographic site requirements for a face-to-face encounter for home
health certification)
The originating site requirements under section 1834(m)(4)(C)(ii)(I) through (VIII) of the Act for episodes
being tested in an EPM to permit a telehealth visit to originate in the beneficiary's home or place of
residence (Except for the originating site requirements for a face-to-face encounter for home health
certification)
CMS waives the payment requirements so that the facility fee normally paid by Medicare to an originating
site for a telehealth service is not paid if the service is originated in the beneficiary's home or place of
residence.
CMS waives the payment requirements to allow the distant site payment for telehealth home visit HCPCS
codes unique to this model to more accurately reflect the resources involved in furnishing these services in
the home by basing payment upon the comparable office visit relative value units for work and malpractice
under the Physician Fee Schedule.
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34. Program Rule Waivers:
Skilled Nursing Facility 3-Day Stay
The SNF 3-day stay rule is waived for the AMI model only.
CMS waives the SNF 3-day rule for coverage of a qualified SNF stay for a
beneficiary who is an EPM beneficiary on the date of discharge from the
anchor hospitalization on or after October 4, 2018.
Beneficiaries discharged pursuant to the waiver must be transferred to SNFs
rated 3-stars or higher for at least 7 of the previous 12 months is charged
pursuant to the waiver as reported on the CMS Nursing Home Compare
website. A list of qualifying SNFs will be posted to the EPM website prior to
each calendar quarter to which it applies.
All other Medicare rules for coverage and payment of Part A-covered SNF
services continue to apply.
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35. Program Rule Waivers:
Skilled Nursing Facility 3-Day Stay
If the EPM hospital discharges a beneficiary to a SNFthat is not a qualified SNF under § 512.450 (b) of
this section and provides the beneficiary with a discharge planning notice to the beneficiary at the
time of discharge to a SNF then the SNF coverage requirements apply and the beneficiary may be
financially liable for uncovered SNF services.
The EPM hospital will be financially liable for the SNF stay and the SNF must not bill the beneficiary
for the costs of the uncovered SNF services furnished during the SNF stay if, subsequent to an EPM
hospital applying the SNF 3-day rule waiver under this section, CMS determines the EPM hospital
discharges a beneficiary to:
• To a SNF that is not a qualified SNF under paragraph (b) of this section and the EPM hospital does
not provide the beneficiary with a discharge planning notice, as described at § 512.450(b)(3);
• That is in an EPM where the SNF 3-day rule waiver is not applicable under paragraph (a) of this
section; or
• Prior to October 4, 2018, where the SNF 3-day rule waiver is not applicable under paragraph (b)
of this section.
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36. Program Rule Waivers: Home Visits
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CMS waives the requirement that services and supplies furnished incident to a
physician's service must be furnished under the direct supervision of the physician (or
other practitioner) to permit home visits as specified in this section.
The waiver of the direct supervision requirement in applies only certain circumstances
such as:
• A beneficiary who has been discharged from an anchor hospitalization.
• The home visit is furnished at the beneficiary's home or place of residence.
• The beneficiary does not qualify for home health services under sections 1835(a) and
1814(a) of the Act at the time of any such home visit.
• The visit is furnished by clinical staff under the general supervision of a physician or non-
physician practitioner.
The number of visits that are furnished to the beneficiary during are:
• AMI episode = up to 13 post-discharge home visits;
• CABG episode = up to 9 post-discharge home visits; and
• SHFFT episode = up to 9 post-discharge home visits.
37. Data Sharing: Specifications
CMS will share data with EPM participant hospitals so they will be able to:
• Evaluate their practice patterns.
• Redesign care delivery pathways.
• Improve care coordination.
In response to a hospital’s request in each applicable model, and in accordance with our
regulations and related privacy laws, CMS will share beneficiary Part A and B claims for the
duration of the episode in
• Summary format,
• Raw claims line feeds, or
• Both summary and raw claims.
We anticipate data sharing with participant hospitals will begin in the late spring. Data will be
available for the hospital’s baseline period and no less often than on a quarterly basis with the
goal of as often as on a monthly basis if practicable during a hospital’s performance period.
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38. Data Sharing: Specifications
CMS will also share aggregate regional claims data with EPM participant
hospitals because regional prices are incorporated when establishing target
prices. These files will provide aggregate expenditure data available for all
claims associated with AMI, CABG, and SHFFT episodes for the U.S.
Census Division in which the EPM participant hospital is located.
In addition, we are exploring making aggregate summary data organized by
anchor MS-DRG, provider type, and region for care for episodes that
would meet the criteria for inclusion in the regional component of EPM
publicly available for non-EPM participants.
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39. Data Sharing: Privacy
Data sharing in EPM fully complies with laws and regulations pertaining to privacy.
The HIPAA Privacy Rule restricts our ability to share beneficiary-identifiable data
with EPM collaborators and non-EPM participants because the selected participant
hospitals are specifically held financially responsible the EPM episodes.
However, we will require a Data Request and Attestation form for each model that
will have a mechanism in place for business associates, as defined under HIPAA, to
receive data directly from CMS on an EPM participant's behalf. This gives participant
hospitals the ability to re-disclose EPM data to their collaborators provided they are
in compliance with HIPAA.
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40. Beneficiary Protections: Access to Care
Beneficiaries’ access to care should not be impacted by the EPMs.
• This is a payment model that changes the payment methodology for
hospitals in select geographic areas.
• Beneficiary deductibles and copayments will not change.
• Beneficiaries may still select any provider of choice with no new
restrictions.
• Beneficiaries may still receive any Medicare covered services with no new
restrictions.
If a beneficiary believes that his or her care is adversely affected, he or she should call
1-800-MEDICARE or contact their state’s Quality Improvement Organization by going
to: http://www.qioprogram.org/contact-zones. The Alternative Payment Models
Beneficiary Ombudsman will also be monitoring the Models and fielding inquiries
from beneficiaries if needed.
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41. Beneficiary Protections: Beneficiary Notification
Beneficiary notification about the EPMs will support transparency.
Beneficiary notification requirements focus the attention of all parties on
the requirement to provide all medically necessary services.
As part of discharge planning and referral, EPM participants must
provide a complete list of HHAs, SNFs, IRFs, or LTCHs that are
participating in the Medicare program, and that serve the geographic
area (as defined by the HHA) in which the patient resides, or in the case
of a SNF, IRF, or LTCH, in the geographic area requested by the patient.
EPM participants must notify beneficiaries of payment implications.
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42. Beneficiary Protections:
Beneficiary Notification by an EPM Participant
EPM participant notification
Required to notify beneficiaries of EPMs upon admission
If the admission is scheduled, the EPM participant must provide notice as soon as the
admission is scheduled
In the event notification is not practicable in the preceding circumstances, notice must be
provided as soon as reasonable practicable, but no later than discharge
What is included in the notice?
• Explanation of the EPMs and possible affect for beneficiary care
• Statement that beneficiary retains freedom of choice to choose providers and services
• Explanation of how patients can access care records and claims data
• Statement that all existing Medicare beneficiary protections continue to be available to
the beneficiary
• A list of the providers, suppliers, and ACOs with whom the EPM participant has a sharing
arrangement
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44. Beneficiary Protections: Monitoring
CMS monitoring assesses compliance with the model requirements
for beneficiary protections.
EPM participants are familiar with both bundled payment and risk-
sharing and are unlikely to compromise patient care.
Nonetheless, CMS will monitor for potential risks such as:
• Attempts to increase profit by delaying care
• Attempts to decrease costs by avoiding medically indicated care
• Attempts to avoid high cost beneficiaries
• Evidence of compromised quality or outcomes
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45. EPM Compliance with Requirements of Participation
EPM participants, and any entity or individual furnishing a service to a beneficiary during an
EPM episode, must comply with all of the requirements of participation for the model.
CMS may do one or more of the following if an EPM participant fails to comply with any of
the requirements of the EPMs:
1. Issue a warning letter to the EPM participant.
2. Require the EPM participant to develop a corrective action plan.
3. Reduce or remove an EPM participant’s positive net payment reconciliation amount (NPRA)
calculation.
4. Reduce or remove an EPM participant’s CR incentive payment.
5. Require an EPM participant to terminate a sharing arrangement with an EPM collaborator and
prohibit further engagement by the EPM participant in sharing arrangements with the EPM
collaborator.
6. In extremely serious circumstances, expulsion from the model and/or other sanctions including
suspension of payments or revocation from the EPM if indicated.
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46. Evaluation: Focus Areas
The EPM model will include evaluations of Cardiac and SHFFT episodes that focus
on assessing changes in care quality and efficiency including reduced health care
costs.
The evaluation for the Cardiac Rehab Incentive Payment Model will assess changes
in utilization, retention, and duration of cardiac rehabilitation sessions.
Focus areas of evaluation include:
• Payment and utilization impact
• Outcomes/quality
• Referral patterns and market impact
• Experiences of providers and patients
• Unintended consequences
• Potential for extrapolation of results
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47. Cardiac Rehabilitation Incentive Payment Model
In addition to the AMI, CABG, and SHFFT models, the CMS Innovation
Center finalized a cardiac rehabilitation (CR) incentive payment model.
Participants will be IPPS hospitals in 45 MSAs selected from the 98 AMI and
CABG model MSAs, and 45 fee-for-service (FFS) MSAs from the MSAs eligible
for the AMI and CABG models that were not selected for those models.
Incentive payment structure to the CR model participant retrospectively for
each model beneficiary:
$25 for each of the first 11 CR/ICR services during the episode/care period
$175 for each additional CR/ICR service during the episode/care period
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48. Cardiac Rehabilitation:
Beneficiary Incentives
In the proposed rule, we had proposed to allow participating hospitals to provide
transportation to CR/ICR services as an in-kind beneficiary engagement incentive for
beneficiaries to achieve the CR incentive payment model goal of increasing CR/ICR service
utilization.
CMS has finalized policies for beneficiary engagement incentives similar to the in-kind
beneficiary engagement incentives finalized for the AMI and CABG models.
Participant hospitals may choose to provide in-kind patient engagement incentives to
beneficiaries in an AMI care period or CABG care period under the CR incentive payment
model, subject to certain conditions. This includes, for example, that the incentive must be
provided directly by the participant to the beneficiary during relevant care period and that the
item or service provided must be reasonably connected to medical care provided.
Beneficiary engagement incentives involving technology are subject to certain additional
conditions.
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49. Program Rule Waiver: Definition of a
Qualified Physician
Services provided under cardiac rehabilitation (CR)/intensive cardiac
rehabilitation (ICR) programs may be furnished to eligible beneficiaries
during a proposed AMI or CABG model episode.
CR and ICR services must be furnished under the supervision of a qualified
physician.
CMS finalized a waiver to the definition of a qualified physician to include a
non-physician practitioner (defined for the purposes of this waiver as a
physician assistant, nurse practitioner, or clinical nurse specialist) to perform
the specific functions of supervisory physician—prescribing exercise; and
establishing, reviewing, and signing an individualized treatment plan.
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50. Changes to CJR
Finalized policies to align CJR with terminology and policies for the
EPMs, including:
• Meeting the criteria in the Quality Payment Program rule to offer an
Advanced APM track beginning in 2017.
• Exclusion of a small number of beneficiaries aligned to certain ACOs from
CJR.
• Inclusion of reconciliation and repayment amounts when updating data for
quality-adjusted target prices.
• Modifying standard to determine quality improvement on quality
measures.
• Additional types of CJR collaborators.
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51. Additional Sources of Information
The EPM final rule can be viewed at
https://www.federalregister.gov
For more information about the EPMs, go to
https://innovation.cms.gov/initiatives/epm
Email inquiries to epmrule@cms.hhs.gov
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