Arnie Cisneros Awarded CMS Grant for Bundled Payment Initiative

The Centers for Medicare & Medicaid Services (CMS) announced this week that Arnie Cisneros, PT, and Linda Alexander, RN, have been awarded for their Model 2 Retrospective Bundled Payment Initiative entitled “Retrospective Acute Care Hospital Stay Plus Post-Acute Care” in collaboration with Detroit Medical Center (DMC).

CMS received a very enthusiastic response from providers across the country interested in the Bundled Payment Initiative. Over the last two months, CMS reviewed the many proposals, which included thousands of episode definitions, identified points of commonality, and considered numerous key policy and operational issues inherent in designing the bundled payment model on a sizable scale.

Under the Bundled Payments initiative, CMS will link payments for multiple services patients receive during an episode of care. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. Providers will have flexibility to determine which episodes of care and which services would be bundled together.

Cisneros, President of Home Health Strategic Management, and Alexander of Detroit Medical Center, worked with Detroit Medical Center and The Rehab Institute of Michigan to complete the Model 2 Bundling Application, which consists of CMS and providers working together to set a target payment amount for a defined episode of care. Cisneros and Alexander’s proposal included the target price, set by applying a discount to total costs for a similar episode of care as determined from historical data.

Under the Model 2 bundling initiative, participants would be paid for their services under the Original Medicare fee-for-service (FFS) system, but at a negotiated discount. At the end of the episode, the total payments would be compared with the target price. Participating providers may share the gains resulting from the more efficient redesigned care model.

DMC is a collection of nine hospitals that is also a pioneer accountable care organization (ACO) awardee. The Rehab Institute of Michigan, part of DMC, was charged with completing the Model 2 Bundling Application for the ACO project. Throughout the initiative, the DMC contracted with Home Health Strategic Management based on HHSM’s knowledge of post-acute services to create clinical pathways, bundling models, post-acute vendor rosters, and the Model 2 application.

HCAF congratulates Arnie Cisneros and Linda Alexander for this achievement and recognition for being on the forefront of changes within our industry. We are also pleased that they will be co-writing an article in the next issue of our magazine, The Florida Home Care Connection, about their Hospital Readmission Reduction Program. Keep in touch with Cisneros by subscribing to our monthly “Rehab Happenings” webinars that he provides for us. Subscriptions to this live series also includes access to the recorded sessions so you can view on-demand on your own schedule and/or share with staff. Click here for details.

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