|CMS Selects Sites For Demonstration To Improve Quality
The Centers for Medicare and Medicaid Services (CMS) said it has selected sites for the Acute Care Episode (ACE) demonstration.
ACE is a new hospital-based demonstration that will test
the use of a bundled payment for both hospital and physician services
for a select set of inpatient episodes of care to improve the quality
of care delivered through Medicare fee-for-service.
The following sites have been selected to participate in the demonstration:
- Baptist Health System, San Antonio, Texas;
- Oklahoma Heart Hospital LLC, Oklahoma City;
- Exempla Saint Joseph Hospital, Denver, Colo.;
- Hillcrest Medical Center, Tulsa, Okla.; and
- Lovelace Health System, Albuquerque, N.M.
The goal of the ACE demonstration is to use a bundled
payment to better align the incentives for both hospitals and
physicians, leading to better quality and greater efficiency in the
care that is delivered. The demonstration will also test the effect
that transparent price and quality information has on beneficiary
choice for select inpatient care.
The ACE demonstration was open to applicants from Texas,
Oklahoma, New Mexico and Colorado. Each demonstration site, or
"Value-Based Care Center," will be actively marketed to both
beneficiaries and referring physicians.
For purposes of this demonstration, a bundled payment is
a single payment for both Part A and Part B Medicare services furnished
during an inpatient stay. Currently, CMS generally pays the hospital
asingle prospectively-determined amount under the inpatient prospective
payment system for all the care it furnishes to the patient during an
inpatient stay. The physicians who care for the patient during the stay
are paid separately under the Medicare Physician Fee Schedule for each
service they perform.
There are 28 cardiac and 9 orthopedic inpatient surgical
services and procedures included in the bundled payment demonstration.
These elective procedures were selected because volume has historically
been high; there is sufficient marketplace competition to ensure
interested demonstration applicants; the services are easy to specify,
and quality metrics are available for them.
This demonstration provides an opportunity for
Value-Based Care Centers to develop efficiencies in the care they
provide to beneficiaries through quality improvement in clinical
pathways, improved coordination of care among specialists, and
"gainsharing." Gainsharing, or provider incentive programs, allow
physicians and hospitals to share remuneration for implementing and
coordinating improvements in efficiency and quality.
This demonstration also provides an opportunity for
Medicare to share savings achieved through the demonstration with
beneficiaries who, based on quality and cost, choose to receive care
from participating demonstration providers. However, beneficiaries will
still be able to choose a hospital that best meets their needs
(Value-Based Care Center or other) and will not be restricted by this
The ACE demonstration was implemented starting early this year.
Address: Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244; (877) 267-2323, www.cms.gov.