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Downstate Times

The Newsletter for SUNY Downstate
University Hospital of Brooklyn

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ISSUE 3 star MARCH 2013


UHB Selected to Participate in CMS Bundled Payment Pilot Program

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Grace Wong, vice president for managed care and clinical business (shown second from right, first row), and her team will monitor patients' recovery and post-hospital care as part of the program's efforts to coordinate patient services and reduce hospital readmissions.


On January 31, The Centers for Medicare and Medicaid Services (CMS), the federal government agency responsible for administering Medicare, announced that SU NY Downstate has been selected to participate in Model 2 of the Bundled Payment for Care Improvement (BPCI) initiative.

BPCI is a new Medicare program that seeks to improve care by closely coordinating the services Medicare patients receive, both while in the hospital and after discharge. It is part of the government's strategy to move away from fee-for-service payments toward riskbased payment arrangements and to hold providers of care responsible for both the cost and the quality of care delivered. Downstate is the only hospital in Brooklyn testing Model 2, one of four bundled care pilots Medicare is testing.

Called Value Based Purchasing, these new initiatives are part of the Patient Protection and Affordable Care Act. The bundled payment program pays a single rate for a patient's entire "episode of care," and requires regular reporting of patient outcomes. This single payment includes a discount to the Medicare program of 2 to 3 percent and covers all of the care from the time a patient enters the hospital until 90 days after the patient has been discharged.

Downstate's program has been organized by Remedy Partners, Inc, a company created specifically to help hospitals and other healthcare providers develop successful bundled payment programs.

"Remedy provides the analytics, the software tools, extra staffing, and the know-how to succeed with these new payment models," says Grace Wong, vice president for managed care and clinical business, and assistant professor in the School of Public Health.

Up to 48 episodes of care will be covered in the initiative, which is expected to include just over half of all Medicare patients admitted to University Hospital. Downstate is working with select nursing homes and home health agencies to develop care coordination procedures and best medical care practices as part of the program.

"Our goal is to be much more engaged in patients' post-hospital care, to assure they receive the care they need and to avoid a re-hospitalization because a patient doesn't have access to community- based care," says Michael Lucchesi, MD, Downstate's chief medical officer. "The new program will help us monitor and assist in a patient's recovery after hospitalization."

Downstate's BPCI program is expected to go-live on July 1, 2013, as part of a demonstration program that will last for three years. After the demonstration period, many believe this form of payment will become the standard for health care reimbursement for decades to come.