CMS Model 2 Retrospective Payment Bundling Strategy
The purpose of this paper is to provide a brief explanation of the components of the retrospective payment bundling consistent with Centers for Medicare & Medicaid Services (CMS) Model 2 for a 90 day period post-discharge for community acquired pneumonia (CAP) patients. Additional focuses will be placed on health care services needed across the continuum for the bundle payment to be successful. Further emphases will be positioned on the eligible awardees and how the executive team will determine who is included versus excluded form the bundle program. In addition, demonstration of how strong protections are in place to preserve Medicare beneficiary choice in seeking care and the provider of choice. The purpose of the analysis is to discuss the CMS Model 2 retrospective payment bundling strategy as it relates to community acquired pneumonia (CAP) patients utilizing the bundle program. The analysis will address the role of information technology to include episode treatment groupers, capabilities for storing, managing, and analyzing from both financial and clinical data. Additionally, the American Organization of Nurse Executive (AONE) nurse executive competencies will be deliberated in relation …show more content…
The policy delineates if the cost from providing care to a patient surpasses an indicated threshold, the provider receives an additional sum. Primarily, the outlier payment policy functions as an insurance policy for the organization (Sood et al., 2011). Another strategy for the team to curtail costs is by decreasing the amount of post-acute providers they utilize or upsurge the use of inpatient post-acute units. Utilizing these tactics reduces the amount of managerial and administrative weight on the hospitals bottom-line (Sood et al.,
The purpose of this paper is to provide a brief explanation of the components of the retrospective payment bundling consistent with Centers for Medicare & Medicaid Services (CMS) Model 2 for a 90 day period post-discharge for community acquired pneumonia (CAP) patients. Additional focuses will be placed on health care services needed across the continuum for the bundle payment to be successful. Further emphases will be positioned on the eligible awardees and how the executive team will determine who is included versus excluded form the bundle program. In addition, demonstration of how strong protections are in place to preserve Medicare beneficiary choice in seeking care and the provider of choice. The purpose of the analysis is to discuss the CMS Model 2 retrospective payment bundling strategy as it relates to community acquired pneumonia (CAP) patients utilizing the bundle program. The analysis will address the role of information technology to include episode treatment groupers, capabilities for storing, managing, and analyzing from both financial and clinical data. Additionally, the American Organization of Nurse Executive (AONE) nurse executive competencies will be deliberated in relation …show more content…
The policy delineates if the cost from providing care to a patient surpasses an indicated threshold, the provider receives an additional sum. Primarily, the outlier payment policy functions as an insurance policy for the organization (Sood et al., 2011). Another strategy for the team to curtail costs is by decreasing the amount of post-acute providers they utilize or upsurge the use of inpatient post-acute units. Utilizing these tactics reduces the amount of managerial and administrative weight on the hospitals bottom-line (Sood et al.,