医疗保险中心 & Medicaid 云顶集团 (CMS) is offering a second—and likely final—application period for BPCI Advanced, 新的捆绑支付模式. 6月24日前提交非约束性申请的医疗机构, 2019, can participate in the second cohort and begin assuming risk for selected episodes beginning January 1, 2020. While organizations may be tempted to quickly complete the BPCI Advanced application and submit it as soon as possible, they should take advantage of the application period to gain an understanding of the current capabilities associated with the sections listed below—doing so will help them jump-start the process to operationalize many of the key components needed to implement BPCI Advanced.
- 组织能力和准备情况
- 护理改进
- 质量改进
- 云顶集团40011官网订婚
- 财务安排/净付款调节金额(NPRA)共享
实现治理结构需要时间, 制定护理再设计策略, 和云顶集团40011官网结盟. 编制一份组织能力的清单可能有助于加快组织能力的发展 选集过程. Organizations that elect to participate in the second cohort are financially responsible for episodes beginning January 1, 2020, 只给他们短短七个月的时间来申请模型, 分析数据,选择情节,并提交所有其他模型交付物,如图1所示. 因此, using the application period to strategize will position organizations for success under BPCI Advanced.
治理
组织能力和准备
A dedicated bundled payment governance structure provides accountability and can serve as a framework to make decisions, 调整策略, 实现效率. We recommend a bilevel governance structure that includes a steering committee and functionally oriented work groups (or 临床效果小组 [CETs]),它们将协同实施捆绑支付. The inclusion of both levels of governance allows for multidisciplinary and effective collaboration. 建立有效的治理结构, 机构应利用申请期:
- 确定指导委员会和工作组/CET成员.
- 指导委员会和各工作组/CET的章程草案, 概述他们的目的, 责任, 短期优先事项.
- 教育利益相关者并制定沟通计划.
A formalized governance structure provides accountability and helps ensure that all bundled payment tasks are managed and completed in a timely fashion.
护理重新设计
护理改进
The BPCI Advanced model aims to encourage organizations to improve care delivery by adopting best practices, 减少护理标准的差异, 并提供符合临床水平的云顶集团. 根据BPCI高级标准,护理标准化活动通常包括以下内容:
- 护理设计:确定并记录患者接受的云顶集团, 以及这些云顶集团的时间安排, 从急性住院到出院后90天, 确保临床方案/途径和医嘱集也保持一致.
- 护理协调记录高风险的过程, high-cost patients are identified and the criteria used to discharge patients to the next site of care.
- 护理过渡: Review and revise patient discharge instructions to ensure they provide clear and concise direction to patients based on a hierarchy of clinical issues.
- 重新接纳减少: Develop screening criteria to be used to identify patients who are at high risk for readmission.
With regard to care improvement efforts, 机构应利用申请期:
- Identify which care standardization activities should be prioritized and determine whether any activities can begin regardless of which episodes are ultimately selected.
- 制定概述具体职责的高层实施计划, 有效利用现有资源, and identifies any additional required resources in order to increase effectiveness and avoid duplicate work.
These preparatory activities will ensure that organizations have all the pieces in place to begin care redesign activities once episodes are selected in November 2019.
质量改进
护理重新设计的一个关键组成部分是持续监测绩效. 因此, organizations will need to identify key performance indicators/outcomes measures that will enable them to evaluate the effectiveness of redesign activities across the continuum of care for selected BPCI Advanced episodes. 鉴于许多医院的电子病历系统的复杂性, early stakeholder input in choosing the measures will give organizations time to develop reporting infrastructure prior to the start of BPCI Advanced. 协助建立有效的绩效监控, 机构应利用申请期:
- 为目标指标开发并记录数据定义.
- 开发自动化的仪表板和报告,并将其集成到所有护理站点.
从1月1日开始监控性能, 2020, will allow organizations to continually identify opportunities and course correct prior to the first reconciliation calculation.
云顶集团40011官网对齐
云顶集团40011官网订婚
One of the benefits of bundled payment models is that they provide organizations with an opportunity to engage physicians in improving care in collaboration with the health system and other providers. Organizations have the most success with bundled payments when physicians are involved in the program and take leadership roles to ensure favorable outcomes. Regarding improving physician engagement, 机构应利用申请期:
- Identify which physicians are best suited to be leaders or champions of the bundled payment programs.
- Review the status of physician engagement in key service lines and identify gaps that will need to be addressed in order to implement a bundled payment program.
An initial review of provider engagement during the application period will help organizations both evaluate their readiness for bundled payments and prioritize particular service lines that are the best candidates for implementing a bundled payment from the perspective of provider engagement.
财务安排/NPRA共享
BPCI Advanced允许参与者分享通过该计划获得的储蓄, 云顶集团40011官网获得高质量结果的额外激励是什么. Savings are generated when the actual cost of the episode is less than the target price set by CMS. 这些节余汇入付款调节净额, which can then be shared between the health system and participating physicians per OIG regulations.
Organizations that have planned for this shared savings methodology during the application process will be well positioned for implementation at the start of the program. 确定共享伙伴可能是一个繁琐且耗时的过程, so establishing a detailed plan for the financial arrangements up front will position organizations for success.
计划为成功奠定基础
根据我们的经验, organizations that use the BPCI Advanced application period to begin developing a governance structure, 优先考虑护理重新设计活动, 在这种模式下,与医疗保健提供者合作将会很好. BPCI Advanced was designed to support providers who invest in care redesign to improve quality and reduce expenditures. 因此, 结构就越坚固, 处于更好位置的组织将是管理事件.出版于2019年6月17日