Ch. 3 - Payment Reform (p. 47)

Question 1

This program reduces payments to hospitals with excessive readmissions.

Answer 1

Hospital Readmissions Reduction Program (HRRP)

Question 2

CMS reduced the base operating payment for hospitals, with the opportunity to gain back payment based on quality performance.

Answer 2

Hospital Value-Based Purchasing (VBP)

Question 3

Launched as a direct result of ACA. Models range from full capitation to FFS payments during year with reconciled payments based on quality and cost performance. The latter model seeks to distribute shared savings of treating the population between the payer and the providers.

Answer 3

Accountable Care Organizations (ACOs)

Question 4

Most significant programs launched by CMS: Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR). CMS shifts risk to providers by determining target price for clinical episodes and holding providers financially accountable if provision of services within episode is higher than target.

Answer 4

Bundled Payments

Question 5

CMS reduces payments to hospitals ranked among lowest in prevention of patient conditions linked to hospital care and should be avoidable (e.g., surgical site infections).

Answer 5

Hospital-Acquired Condition (HAC) Reduction Program