The Centers for Medicare & 医疗补助bet8娱乐(CMS)为BPCI Advanced提供了第二个,也可能是最后一个申请期, the new bundled payment model. Healthcare organizations that submit a nonbinding application by June 24, 2019, 是否可以参加第二队列,并从1月1日开始承担选定发作的风险, 2020. 虽然组织可能会试图快速完成BPCI高级应用程序并尽快提交, 他们应该利用应用程序期来了解与下面列出的部分相关的当前功能,这样做将帮助他们快速启动实现BPCI Advanced所需的许多关键组件的操作过程.
- Organizational capabilities and readiness
- Care improvement
- Quality improvement
- Practitioner engagement
- Financial arrangements/Net Payment Reconciliation Amount (NPRA) sharing
It takes time to implement a governance structure, develop care redesign strategies, and align physicians. Taking an inventory of organizational competencies may help expedite the episode selection process. 选择参加第二组的组织将为1月1日开始的剧集负责, 2020, giving them only seven short months to apply to the model, analyze data, select episodes, and submit all other model deliverables, as demonstrated in figure 1. Therefore, 利用申请期制定战略将使组织在BPCI Advanced下取得成功.
Governance
Organizational Capabilities and Readiness
专用的捆绑支付治理结构提供了问责制,并可作为决策框架, align strategies, and achieve efficiencies. 我们建议采用双层治理结构,包括指导委员会和面向功能的工作组(或团队) Clinical Effectiveness Teams [CETs]), which will work in tandem to implement bundled payments. 包括这两个级别的治理允许多学科和有效的协作. In establishing an effective governance structure, organizations should use the application period to:
- Identify steering committee and work group/CET members.
- Draft charters for the steering committee and each work group/CET, outlining their purpose, responsibilities, and short-term priorities.
- Educate stakeholders and develop a communication plan.
正式的治理结构提供了问责制,并有助于确保及时管理和完成所有捆绑支付任务.
Care Redesign
Care Improvement
BPCI高级模型旨在鼓励组织通过采用最佳实践来改善护理bet8娱乐, reducing variation in standards of care, and providing a clinically appropriate level of services. Under BPCI Advanced, care standardization activities often include the following:
- Care Design: Identify and document the services received by patients, as well as the timing of those services, from acute hospitalization through 90 days after discharge, ensuring that clinical protocols/pathways and order sets are also aligned.
- Care Coordination: Document the process by which high-risk, 确定高费用患者并使用标准将患者转移到下一个护理地点.
- Care Transitions:根据临床问题的层次,审查和修改病人出院说明,确保为病人提供清晰、简明的指导.
- Readmission Reduction制定筛查标准,用于识别再入院高危患者.
关于护理改善工作,组织应利用申请期:
- 确定哪些护理标准化活动应该优先进行,并确定是否可以开始任何活动,而不管最终选择哪一次.
- Develop a high-level implementation plan that outlines specific responsibilities, uses existing resources efficiently, 并确定任何额外所需的资源,以提高效率并避免重复工作.
这些准备活动将确保各组织在2019年11月选定病例后,具备开始护理重新设计活动的所有条件.
Quality Improvement
A crucial component of care redesign is the continual monitoring of performance. Therefore, 组织将需要确定关键绩效指标/结果测量,这将使他们能够评估在选定的BPCI晚期发作的连续护理中重新设计活动的有效性. Given the complexities of many hospitals’ EHR systems, 利益相关者在选择度量时的早期投入将使组织有时间在BPCI Advanced开始之前开发报告基础设施. To aid in establishing effective performance monitoring, organizations should use the application period to:
- Develop and document data definitions for targeted metrics.
- Develop dashboards and reports that are automated and integrated across all sites of care.
The ability to monitor performance beginning January 1, 2020, 是否允许组织在第一次对账计算之前不断地识别机会和纠正路线.
Physician Alignment
Practitioner Engagement
捆绑支付模式的好处之一是,它们为组织提供了让bet8网站备用与bet8网站备用和其他提供者合作改善护理的机会. 当bet8网站备用参与项目并发挥领导作用以确保有利的结果时,组织在捆绑支付方面取得了最大的成功. 关于提高bet8网站备用参与度,组织应利用申请期:
- 确定哪些bet8网站备用最适合成为捆绑付款计划的领导者或拥护者.
- 审查bet8网站备用在关键bet8娱乐项目中的参与情况,并确定需要解决的差距,以便实施捆绑支付计划.
在申请期间对提供商参与情况进行初步审查,将有助于组织评估他们对捆绑支付的准备情况,并从提供商参与的角度优先考虑实施捆绑支付的最佳候选特定bet8娱乐线.
Financial Arrangements/NPRA Sharing
BPCI Advanced allows for participants to share in the savings earned through the program, which serves as an additional incentive for physicians to achieve high-quality outcomes. 当剧集的实际成本低于CMS设定的目标价格时,就会产生节省. These savings are pooled into the Net Payment Reconciliation Amount, 这些信息可以根据监察长组织的规定在bet8网站备用和参与的bet8网站备用之间共享.
在申请过程中规划了这种共享节约方法的组织将在项目开始时就处于实施的有利地位. Identifying sharing partners can be a cumbersome and time-consuming process, 因此,预先为财务安排制定详细的计划将使组织获得成功.
Planning Sets the Stage for Success
In our experience, 使用BPCI Advanced应用程序期开始开发治理结构的组织, prioritizing care redesign activities, and engaging with healthcare providers will do well under this model. BPCI高级版旨在支持投资于护理重新设计的提供者,以提高质量并减少支出. Therefore, the more robust the structures in place, the better positioned organizations will be to manage episodes.Published June 17, 2019