Glossary of Key Terms and Acronyms
The period of time between the admission date and the discharge date of an episode-initiating hospital stay for a patient.
A non-provider entity that participates in the BPCI Initiative as a convening organization that brings together multiple health care providers, enters into agreements with CMS and shares financial risk for the patient of its episode-initiating partnering providers.
In Models 2 and 3 of the BPCI Initiative, this is a retrospective payment that represents the difference between the predicted and actual utilization of healthcare services during a defined period.
An evidence-based tool developed by Remedy Partners to support inpatient clinical decision makers in transitioning BPCI patients to their optimal next care setting.
Care at the Right Location (CARL Tool)
A Medicare billing code that reimburses physicians or non-physician clinicians for non-face-to-face care coordination services provided to Medicare patients. To qualify, Medicare patients must have two or more chronic conditions.
Chronic Care Management Code (CCM)
A patient questionnaire that determines follow-up call frequency by stratifying patients into high or low risk levels based on clinical and social factors; administered at the beginning and halfway points of the episode.
CLINICAL RISK ASSESSMENT TOOL
The event that triggers inclusion in the episode. In Model 2, this is the admission to a participating acute care hospital for the agreed-upon MS-DRG. In Model 3, this is the initiation of post-acute services at a participating organization (Long Term Care Hospital, Skilled Nursing Facility, Independent Rehab Facility, or Home Health Agency) within 30 days of beneficiary discharge from an acute care hospital stay for an agreed-upon MS-DRG.
A care management platform created by Remedy Partners that allows providers to access the episode’s data feed, manage care coordination plans, track patients and send HIPAA secure messages to care teams.
Episode of Care (Episode)
A period of time that begins with the stay in an acute care hospital or SNF and extends 30, 60, or 90 days after discharge. BPCI Initiative participants can select up to 48 different clinical condition episode types that qualify for bundled payment reimbursement. An episode includes all health care items and services furnished during the specified time period.
Episode Initiator (EI)
An entity that triggers an episode. Examples of Remedy Episode Initiators include Acute-Care Hospitals, Physician Group Practices, Skilled Nursing Facilities and Home Health Agencies.
Episode-Integrated Provider (EIP)
A Medicare provider or supplier, including but not limited to an Episode Initiator.
A periodic comparison of the total FFS payment to providers for services included in the episode vs. the predetermined target price for theepisode. If aggregate FFS payments are less than the predetermined target price, the Awardee will be paid the difference, which may be shared among the participants.
Episodic Length of Stay (ELOS)
The total number of SNF days during a 90-day episode. Remedy hasdeveloped ELOS benchmarks in which a patient will likely meet baseline functional and clinical goals – an indication they can be safely discharged. The ELOS benchmarks were derived for each bundle from the top quartile of the CMS Limited Data Set 2010-2012.
The payment system in which Medicare pays healthcare providers directly for Part A and/or Part B benefits on a service-specific basis according to the specific statutory payment rules.
A physician, non-physician practitioner, or a physician group practice that is participating in care redesign and has entered into a written gainsharing agreement with an EIP.
An arrangement memorialized in a Participant Agreement between the Awardee Convener and the participating EIP for determining Internal Cost Savings and NPRA contribution to and distribution from the BPCI Savings Pool.
A payment made directly or indirectly from the BPCI Savings Pool to anAwardee or EIP pursuant to a Gainsharing Arrangement, or a paymentof a portion of the BPCI savings from an EIP to a Gainsharer, pursuant to a written gainsharing agreement between the EIP and the Gainsharer. These payments are for care redesign activities performed as part of the BPCI program.
Internal Cost Savings
Measurable, actual, and verifiable cost savings realized by the EIP resulting from care redesign undertaken by the EIP in connection with providing items and services to beneficiaries within specific episodes.
Needs Assessment Tool
A patient or caregiver phone interview administered by a care coordinator to identify follow-up needs, book appointments, social support systems, make emergency plans, recognize patient symptoms and/or review other unmet needs that may lead to poor health outcomes and readmissions.
Net Payment Reconciliation Amount (NPRA)
The difference between the target price and the total dollar of Medicare fee-for-service expenditures for items and services (collectively referred to as Aggregate FFS Payment) furnished by the Awardee, the Episode Initiator, EIPs, Gainsharers, or third party providers during the episode.
A web service platform that provides patients with access to health record information, tracks their care coordination plan, supports their care coordination, and communicates with their providers.
A repository of documents, articles and tools, accessible from Remedy Connect that supports Physician Champions in the development of aPhysician Champion Plan.
The period of time spanning 30, 60, or 90 days from of an Anchor Stay.
Principle Accountable Attending Practitioner (PAP)
Typically the surgeon (for surgical bundles) or the designated attending physician (for medical bundles). A PAP may also be the patient’s PrimaryCare Provider (PCP) or patient’s Primary Care Provider (PCP) or Hospitalist. Each episode is typically assigned two Principal Accountable Practitioners, one for the inpatient stay and one for the post-discharge period.
A web service platform that provides real-time patient data to physicianscaring for BPCI patients. The platform provides episode notifications and a place for physicians to complete the Physician Cooperation Survey.
Using a single point of entry, Remedy Connect allows access to Episode Connect, Remedy University, reporting, the Physician Toolkit and otherRemedy modules.
Skilled Nursing Facility (SNF) Performance Network
A narrowed network of skilled nursing facilities within a local market. This Network represents the top 75% of centers within a given region as measured through qualitative and quantitative evaluation of performance and operational capabilities. The Network is promoted through clinician-facing and patient-facing materials, and is managed by Remedy's Post-Acute Network Representatives.
A Medicare billing code that provides compensation to physicians thatperform transitional care services in the 30 days immediately after discharge.
Transitional Care Management Code
Affordable Care Act
Acute Care Hospital
Accountable Care Organization
Bundled Payments for Care Improvement (Initiative)
Clinical Documentation Improvement
Center for Medicare and Medicaid Innovation
Dedicated Case Manager
Home Health Agency
Home Health Resource Group
Inpatient Rehabilitation Facility
Long-Term Acute Care Hospital
Medicare Severity-Diagnosis Related Group
Medicare Shared Savings Program
National Provider Identifier
Next Site of Care
Primary Care Physician
Physician Group Practice
Skilled Nursing Facility
Transitional Care Lead
Transitional Care Network
Tax Identification Number