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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)
slide4
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
slide5
Selected orthopedists recommended by WSMA and Lyle Sorensen, MD, chair of WA Ortho Association asked to provide clinical input on draft, by April 5
  • Draft warranty will be posted for public comment (and well publicized), mid April or June
slide6
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
slide7
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)
slide9
UNDER DISCUSSION
  • 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
slide10
5 Broad Categories of Measures
  • Evidence-based Care
  • Functional Improvement (Pre and post operation) 
  • Patient Satisfaction
  •  Readmissions
  • Other, e.g., Reduction in time out of work
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