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Accountable Payment Model (APM) Workgroup Update. Bree Collaborative Meeting March 27, 2013. Overview. Have met two times since the last Bree Collaborative meeting (6 meetings total) RECAP – Tasked with recommending a “common playbook” for one episode of focus

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Accountable payment model apm workgroup update

Accountable Payment Model (APM) Workgroup Update

Bree Collaborative Meeting

March 27, 2013


Overview
Overview

  • Have met two times since the last Bree Collaborative meeting (6 meetings total)

  • RECAP – Tasked with recommending a “common playbook” for one episode of focus

  • Extensive review of materials from diverse sources

    • Materials from the CMS-Commissioned High Value Healthcare Collaborative and bundle payment pilots in California (IHA) and Wisconsin (Meriter)

    • Three datasets about readmissions to inform decision about appropriate warranty length and list of complications (Medicare FFS, Premera, & CMS project)



  • Draft warranty has been completed (see handout)

  • 4 Components

    • Diagnostic code for osteoarthritis (excludes trauma, cancer and congenital malformation)

    • Procedural codes for TKR and THR

    • Age limits

    • Definition of complications (and codes) excluded from additional reimbursement

    • Definition of warranty period



  • Group has reviewed appropriateness criteria of the TKR/THR value stream developed by Virginia Mason

    • Disability: reduced function and pain due to osteoarthritis despite conservative therapy

    • Fitness for surgery: patient engagement and physical preparation

  • Virginia Mason is working on evidence appraisal for these criteria


At its next meeting, group will review standards for surgery and rehab function of the TKR/THR value stream to define value-added elements that must be included in the bundle

  • Repair of the osteoarthritic joint

  • Recovery from surgery and return to function

  • Interest in bringing on a consultant to help with the non-clinical, administrative components (next slide)


  • Progress in developing components
    Progress in Developing Components and rehab function of the TKR/THR value stream to define value-added elements that must be included in the bundle


    UNDER DISCUSSION and rehab function of the TKR/THR value stream to define value-added elements that must be included in the bundle

    • Draft quality measures will be reviewed by group at next meeting

    • Criteria for selection:

      • Reflect the quality of care for patients who received THR or TKR

      • Aligned to the greatest extent possible with measures in other CMS programs

      • Are nationally-vetted measures (not home-grown)

      • Designed for potential use in public reporting


    5 Broad Categories of and rehab function of the TKR/THR value stream to define value-added elements that must be included in the bundleMeasures

    • Evidence-based Care

    • Functional Improvement (Pre and post operation) 

    • Patient Satisfaction

    •  Readmissions

    • Other, e.g., Reduction in time out of work


    Questions comments
    Questions? Comments? and rehab function of the TKR/THR value stream to define value-added elements that must be included in the bundle


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