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Accountable Payment Model (APM) Workgroup Update

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

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  1. Accountable Payment Model (APM) Workgroup Update Bree Collaborative Meeting March 27, 2013

  2. 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)

  3. Four Areas of Work

  4. 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

  5. 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

  6. 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

  7. 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)

  8. Progress in Developing Components

  9. 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

  10. 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

  11. Questions? Comments?

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