Bundled Payments and Accountable Care Organizations: Where are We and What are the Implications for Post-Acute Care? May 29, 2015 avalerehealth.

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1 Bundled Payments and Accountable Care Organizations: Where are We and What are the Implications for Post-Acute Care? May 29, 2015 avalerehealth.net

2 Today s Agenda Affordable Care Act Accelerates Transition Toward Value Based Care Bundled Payment Accountable Care Organizations (ACOs) Discussion/Q&A 2

3 The ACA Had Three Principle Goals Coverage & Insurance Market Reform Make insurance more accessible and affordable for all individuals Delivery & Payment System Reform Pay for quality instead of volume of care Financing Strategies for Health Reform Find sustainable funding to pay for reform provisions 1) The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L , enacted on March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 (HCERA), P.L , enacted on March 30,

4 ACA Accelerated Participation in VBP and Alternative Payment Models Medicare Spending Per Beneficiary Measure Added to Hospital VBP Over 4,000 new BPCI Participants & Deadline for Phase II Riskbearing BPCI Pilot Begins October 1 Over 2,300 BPCI Participants in Phase I As of Jan. 2014, CMS Sponsoring 366 ACOs As of Jan. 2015, CMS Sponsoring 424 ACOs Readmissions Reduction Program Begins 106 New MSSP Participants Announced AMI, Pneumonia, Heart Failure (1%) AMI, Pneumonia, Heart Failure (2%) AMI, Pneumonia, Heart Failure, COPD, THA/TKA (3%) Oct FY2013 FY2014 FY2015 4

5 Medicare will Implement Value-Based Payment for SNFs in 2019 FY 2019 SNF Payments will be Partly Based on Hospital Readmission Rate CMS will withhold two percent of all SNF per diem payments for SNF Value-Based Payment Program (SNF VBP) o o Up to 70 percent of withhold will be redistributed as incentive payments to SNFs for relatively high performance on readmission measures; SNFs scoring in the bottom 40 percent each year will receive lower payments Unlike the broader hospital program, SNF VBP focuses solely on SNF readmissions. Performance Period for SNF VBP Still Unclear but Could Include 2015 HRRP uses a 3-year performance period that ends one year prior to when the penalties are assessed. If CMS uses the same timeframe, penalties for FY 2019 will be based on claims data from Program Still Not Fully Defined CMS will propose more details on SNF value-based purchasing in future rulemaking. CMS is currently seeking comments on: performance standards, measuring improvement, appropriate baseline and performance periods, performance scoring methodology, public reporting of performance information, and feedback reports 5 Federal Register, FY 2016 Proposed Rule for Skilled Nursing Facilities. April 20, (75):

6 And CMS will Begin Collecting Standardized Data in All Post-Acute Care Settings by 2018 (2019 for HHAs) BY 2018 OR 2019, ALL PAC PROVIDERS HHA, SNF, IRF, AND LTCH WILL BE REQUIRED TO REPORT STANDARDIZED PATIENT ASSESSMENT DATA Standardized Patient Assessment Data PAC providers must submit data for standardized quality measures and data for resource use or other measures as necessary to supplement claims For example, HHAs submit data through modified OASIS Standardized Quality Measures Functional status Cognitive function Skin integrity Medication reconciliation Incidence of major falls Communication of health information and care preferences during transfers Standardized Resource Use Measures Resource use measures, including total estimated Medicare spending per beneficiary (MSPB) Discharge to community Measures reflecting allcondition risk-adjusted potentially preventable hospital readmission rates PAC Providers must report on the required measures or be subject to a 2 percent reduction in their market basket percentage 6

7 Momentum Will Likely Continue Into the Future: CMS Sets Explicit Goals 30% Medicare Advantage 30% Medicare Advantage Medicare % Fee- For-Service 33% Medicare Advantage 30% Medicare Advantage 67% Fee-For- Service Medicare % Medicare Advantage 33% Medicare Advantage 25% In APMs 75% Traditional FFS 50% In APMs 50% Traditional FFS Volume-Based Payment Value-Based Payment In addition to the APM goals, CMS set a goal of having the percentage of Medicare payments that are linked to quality and value to reach 85% by 2016 and 90% by 2018 APM=Alternative Payment Model 7

8 ACOs and Bundling Will Succeed Only Through Reduced Utilization NEW MODELS RELY ON REDUCED UTILIZATION FOR SAVINGS AND REQUIRE BETTER COST MANAGEMENT FOR SUCCESS ACCOUNTABLE CARE ORGANIZATIONS MUST SPEND LESS THAN BENCHMARK TO SHARE SAVINGS WITH MEDICARE BUNDLED PAYMENT HOLDERS MUST LOWER OVERALL SPENDING ACROSS AN EPISODE TO YIELD SAVINGS Per Capita Spending ACO Launch Bundled Payment Amount Actual spending Time Spending benchmark Spending per Episode Source: Brookings Institution and Dartmouth Institute for Health Policy and Clinical Practice. The Accountable Care Organization (ACO) Learning Network, October 6,

9 New Jersey SNF Utilization Exceeds the National Average DISCHARGES BY DESTINATION CARE SETTING, MEDICARE FFS 2013 Death 4% STACH 1% Death 4% STACH 1% HHA 10% SNF 28% HHA 14% SNF 20% Other IP 0.5% Home 52% New Jersey IRF 4% Other IP 0.5% LTACH 1% National Home 57% LTACH 1% IRF 4% The 1Vantage The Vantage Care Positioning Care Positioning System System includes includes Medicare Medicare 100 Percent 100 Percent Standard Standard Analytic Analytic File (SAF) File (SAF) fee-forservice claims data from the the Centers for for Medicare and and Medicaid Services (CMS). fee-for-service 9

10 New Jersey SNF Length of Stay and MSPB Exceed National Average HIGH MSPB SCORES AND ALOS LEAD TO FUTURE PAYMENT PENALTIES AND HIGHER EPISODIC SPENDING New Jersey MSPB Score Avg National MSPB Score Avg New Jersey Average LOS (Days), 2013 National Average LOS (Days),

11 Today s Agenda Affordable Care Act Accelerates Transition Toward Value Based Care Bundled Payment Accountable Care Organizations (ACOs) Discussion/Q&A 11

12 Bundled Payment Continues to Gain Policy Momentum President s Budget FY14 & FY15, and FY16 Legislation Bundling and Coordinating Post-Acute Care Act of 2014 (BACPAC) 2014 Hospitals Improvement for Payment Act Regulatory Activity CMS Soliciting Comments on Program/Expansion in IPPS FY 2016 Rule 12

13 CMMI Bundled Payment Models*: High Participation Phase 1 Unclear How Many Will Move to Phase 2 Model 1 Model 2 Model 3 Model 4 Episode All acute patients, all DRGs Selected DRGs + post-acute period PAC only for selected DRGs Selected DRGs Services included in the bundle All Part-A DRG-based payments All Part A and B services (hospital inpatient, hospital readmissions, physician, LTCH, IRF, SNF, HHA, hospital outpatient, independent outpatient therapy, labs, DME, part B drugs) All Part A and B services (hospital readmissions, physician, LTCH, IRF, SNF, HHA, hospital outpatient, independent outpatient therapy, labs, DME, part B drugs) All hospital Part A and physician Part B services plus readmissions Payment Retrospective Retrospective Retrospective Prospective Episode Duration Inpatient stay only Inpatient hospital plus 30/60/90 days 30, 60, or 90 days Inpatient hospital plus 30 days Discount Amount Total Participants Participants in NJ Up to 2 percent* 2-3 percent** 3 percent percent*** 12 2,180 4, *A list of all New Jersey BPCI Participants may be found in the Appendix. ** 0-0.5% in Year 1, 1% in year 2, and 2% in year 3 ***3 percent discount for 30 and 60 day episodes, 2 percent discount for a 90 day episode. **** 3.25 percent applies to select cardiac and orthopedic conditions. Source: CMS Innovation Partner Collaboration Site. Number of participants as of 01/01/

14 BPCI Model 2: Number of Episode Initiators by State (Phases 1 and 2) OR (19) CA (177) WA (80) AK (9) NV (21) ID (15 ) UT (17) AZ (58) MT (8) WY (4) CO (18) NM (12) HI (6) ND (0) SD (9) NE (11) KS (30) OK (18) TX (143) MN (5) IA (12 ) MO (34) AR (18) LA (36) WI (8) IL (76 ) MS (20) MI (41) IN (47) KY (22) TN (190) AL (30) OH (68) GA (27) WV (12) PA (140) SC (36) VA (63) NC (48) FL (196) NY (89) ME (5) VT (1) NH (8) MA (65) RI (5) CT (27) DE (8) MD (1) D.C. (1) NJ (71) Of the 2,180 BPCI Model 2 Participants Nationwide, 3.25% (71 / 2,180) are located in New Jersey. 14

15 BPCI Model 3: Number of Episode Initiators by State (Phases 1 and 2) OR (87) CA (317) WA (109 ) AK (8) NV (18) AZ (93) MT (21) ID (49) WY (11) UT (45) CO (100) NM (27) HI (4) ND (1) SD (6) NE (33) KS (10) TX (469) OK (20) MN (24) IA (17) MO (20) AR (37) LA (44) WI (41) IL (71) MS (14) MI (109) IN (84) KY (127) TN (202) AL (58) OH (258) WV (87) SC (43) GA (128) PA (358) VA (79) NC (151) FL (223) NY (99) ME (32) VT (10) NH (56) MA (184) RI (50) CT (183) DE (21) MD (94) D.C. (1) NJ (203) Of the 4,727 BPCI Model 3 Participants Nationwide, 4.29% (203 / 4,727) are located in New Jersey. 15

16 BPCI Episode Initiators By Participant Type - NJ IN MODEL 3, SNFS ACCOUNT FOR ABOUT THREE-QUARTERS OF ALL EPISODE INITIATORS Model 2: 72 Participants January 2015 Model 3: 203 Participants January % 2% 39% 61% PGP STACH 20% HHA IRF PGP SNF 75% HHA: Home Health Agency; STACH: Short-Term Acute Care Hospital; PGP: Physician Group Practice; IRF: Inpatient Rehabilitation Facility; LTCH: Long-Term Care Hospital Source: https://data.cms.gov/dataset/cms-innovation-center-model-participants/x8pc-u7ta. Accessed 8/4/

17 How Much of the Post-Acute Care Industry Participating in BPCI? PAC PROVIDER FACILITIES MAKE UP 58% OF ALL FACILITIES PARTICIPATING IN BPCI 0.5% 2% PAC Providers In BPCI, By Provider Type Provider Type Total # of Facilities # in BPCI % in BPCI 42% TOTAL # OF FACILITIES IN BPCI: 6,637 51% SNF 15,163 3,360 22% IRF 1, % LTCH % HHA 12, % 5% LTCH IRF SNF HHA Non-PAC* * Non-PAC providers defined as STACHs and PGPs Note: Number of Participants in BPCI on this slide do not match with current data. Used 2014 data to accurately compare with number of facilities. MedPAC June 2014 Data Book. Total number of PAC facilities in 2013 from Chart 8-1: Number of post-acute care providers increased or remained stable in 2013; CMS Bundled Payments for Care Episode Analytic file - Models 1-4 (7/31/14). Link: https://data.cms.gov/dataset/bpci-initiative-all-model-info/eza9-qxqp? 17

18 Most Commonly Selected Clinical Conditions for Models 2 and 3 Risk-Bearing Participants CONDITIONS THAT WERE MOST COMMONLY SELECTED AND THE PERCENTAGE OF ORGANIZATIONS THAT SELECTED THE CONDITION Top Four Conditions Selected by Model 2 Episode Initiators Top Four Conditions Selected by Model 3 Episode Initiators Major joint replacement of the lower extremity (79%) Congestive Heart Failure (24%) Chronic obstructive pulmonary disease, bronchitis, asthma (20%) Hip & Femur Procedures except major joint (19%) Congestive Heart Failure (66%) Major joint replacement of the lower extremity (53%) Simple Pneumonia and Respiratory Infections (34%) Chronic obstructive pulmonary disease bronchitis asthma (32%) On average, Model 2 episode initiators selected only 5 Phase 2 conditions On average, Model 3 episode initiators selected 4 Phase 2 conditions Note: Most common episodes in Risk-Bearing Phase (Phase 2) for Models 2 and 3 for Round 1 of the BPCI as of January 1,

19 Why PAC Providers Participate? Be on the leading edge of possible payment reform and healthcare policy changes Serve as a catalyst to transform business model and partnerships Experiment with clinical redesign Have a stronger voice regarding future policy and payment reform changes Financial break-even, at minimum 19

20 Early Experience from BPCI CMS RELEASED YEAR-ONE PERFORMANCE DATA, WHICH WAS INCONCLUSIVE Key Challenges for Participants Real-Time Communication & Patient Tracking Across Continuum Organizational Structure & Ability to Execute Complexity of Care Redesign & Partnerships Impact of Reduction in Services Identifying Patients (DRG, IT tools, etc) Low Volume to Share Risk Retrospective Reporting 20

21 Today s Agenda Affordable Care Act Accelerates Transition Toward Value Based Care Bundled Payment Accountable Care Organizations (ACOs) Discussion/Q&A 21

22 ACOs Have Many Configurations PHYSICIAN GROUPS AND HOSPITALS FORM AND ADMINISTER MOST ACOs Illustrative ACO 1 Illustrative ACO 2 Illustrative ACO 3 Hospital Physician Practices Hospital Primary Care Group Multi- Specialty Group Mental Health Facility Post-Acute Care Facility Primary Care Group Multi- Specialty Group Home Health Public and private payers sponsor ACOs, enabling providers to share in cost savings if they meet or exceed certain performance thresholds (e.g., minimum shared savings, quality measures) ACO: Accountable Care Organization Sources: 1. Adapted from The Accountable Care Organization (ACO) Learning Network. Brookings Institution and Dartmouth Institute for Health Policy and Clinical Practice. October 9, Accountable care growth in 2014: A look ahead. Available at: 22

23 7.8 Million FFS Medicare Beneficiaries Are Assigned to One of 424 Medicare ACOs Operating in 2015 CA* (38) OR (4) AK WA (4) NV (6) ID (2) UT (3) AZ* (12) MT (2) WY (2) NM (5) CO (3) HI ND (2) SD (1) NE (3) KS (9) TX (34) OK (8) MN* (7) IA* (9) MO (15) AR (10) LA (6) WI* (12) IL* (27) MS (7) MI* (22) IN* (24) TN (13) AL (6) OH (16) KY (12) WV (7) GA (21) PA* (24) VA (22) NC (19) SC (9) PR - 2 FL (49) VT - 5 NY* (36) ME* (4) DE - 3 MD - 23 D.C. - 8 NH* - 10 RI - 4 MA* - 24 CT - 15 No ACOs 1-5 ACOs 6-10 ACOs ACOs ACOs ACOs 26+ ACOs ~25% of Medicare FFS physician spending in 2015 is for beneficiaries assigned to a Medicare ACO, according to the CMS actuary. NJ (24) 1 ACO: Accountable Care Organization; MSSP: Medicare Shared Savings Program *State has both Pioneer and MSSP ACOs; Note: State totals do not sum to 424 since many ACOs operate across several states. 2 Source: Based on the most recent MSSP and Pioneer ACO participant lists available from Data.CMS.Gov, last updated April 2014 and December 2015, respectively, and the list and press release issued by the Centers for Medicare & Medicaid Services in December 2014 for the 89 MSSP ACOs that began participating in January

24 Commercial Payers Are Sponsoring at Least 209 ACOs Across 38 States CA (30) OR (3) AK WA (4) NV (1) ID AZ (9) UT (2) MT WY NM CO (11) HI ND SD NE (1) KS (1) TX (12) OK MN (3) IA (7) MO (2) AR (1) LA (2) WI (5) IL (6) MS MI (2) IN (3) TN (9) AL OH (8) KY (1) GA (3) WV (1) PR PA (12) SC (6) VA (8) NC (10) FL (13) VT - 1 NY (8) ME (10) NH - 5 MA - 2 RI - 2 CT - 8 NJ - 7 DE MD - 1 DC No Commercial ACOs Commercial ACOs ACO: Accountable Care Organization Note: Map counts ACOs that operate in multiple states toward the totals for each of those states. ACOs that have agreements with multiple commercial payers only count once. This map was created using publicly available information. The actual number of commercial ACOs may vary depending on criteria used to define an ACO contract. 24

25 Pioneer ACO Model Met CMS Criteria for Expansion AN INDEPENDENT EVALUATION ASSESSED PIONEER ACOs ON SPENDING, QUALITY, AND UTILIZATION IN COMPARISON TO THEIR LOCAL MARKET AND OTHER SIMILAR MARKETS; THE EVALUATION FOUND THAT: $384M total savings accrued during PY1 (2012) and PY2 (2013) $175.2 more savings were accrued in PY1 ($279.7M) versus PY2 ($104.5M); the savings translate into $35.62 PBPM in 2012 and $11.18 PBPM in * Pioneer ACOs had statistically significant savings in PY1 and PY2. These 10 ACOs experienced notable reductions in acute inpatient stays 12* ACOs had no statistically significant savings or losses in PY1 and PY2 In addition, the evaluators found that Pioneer ACOs: Had statistically significant reductions in admissions for COPD, older adult asthma, and heart failure, though not for 30-day unplanned readmissions Demonstrated that provider engagement activities may have some relationship on ACO performance** Did not have spillover effects*** on non-aco aligned Medicare FFS beneficiaries Determined that interoperability remains a challenge for most Pioneer ACOs In May 2015, CMS certified that the Pioneer ACO model met its criteria for model expansion. In addition, CMS found that the Pioneer ACOs were able to generate greater relative savings to Medicare than MSSP ACOs Note: the ACO evaluation team differs from that used by CMS, so cost savings numbers are not the same. *There were 32 Pioneer ACOs in PY1 and 23 ACOs in PY2; currently there are 19 Pioneer ACOs **Evaluators also assessed the impact of hospital relationships, capacity to follow/monitor beneficiaries across the care continuum, leadership, and other market pressures, but did not find any correlation between those characteristics and ACO performance ***Spillover effects occur when a Pioneer ACO has directly or indirectly impacted the care of non-aco beneficiaries in its near market ACO: Accountable care organization; CMMI: Center for Medicare & Medicaid Innovation; CMS: Centers for Medicare & Medicaid Services; PY: Performance Year; PBPM: Per beneficiary per month; FFS: Fee-for-service; COPD: Chronic obstructive pulmonary disease; MSSP: Medicare Shared Savings Program Source: CMMI. Evaluation of CMMI Accountable Care Organization Initiatives. March Available at: 25

26 Successful ACOs Have Honed Key Core Capabilities Health Information Technology Capture patient medical information in enterprise-wide EHRs Utilize data analytics to risk-stratify patients and target interventions relative to their needs Patient Engagement Engage patients and caregivers by providing education tailored to their unique needs throughout episodes of care (e.g., teach back, peer groups) Offer patient-specific resources to monitor and track chronic conditions and to communicate in a direct and timely manner with providers Clinical Operations Use evidence-based guidelines and clinical decision support to select treatments that are most clinically appropriate Implement processes for coordinating care to smooth transitions between settings of care and interventions that prevent exacerbations of conditions Business Operations Pursue value-based contracts with other public and private payers to align incentives among ACO participants and distribute the cost of ACO investments Use provider scorecards to track and reward high performance (e.g., incentive payments) Network Development Identify high-quality, preferred post-acute partners to reduce avoidable readmissions Employ high-performing physicians and establish patient-centered medical homes to better coordinate care for attributed patients EHR: Electronic Health Record ACO: Accountable Care Organization 26

27 ACOs Must Think Through Key Dimensions Related to Post-Acute Care ACOS MUST CONSIDER PAC RELATIONSHIPS ACROSS SEVERAL DIFFERENT DIMENSIONS. Number and type of post-acute care provider partners and geographic locations Sufficient capacity to enable the ACO to access to the right level of post-acute to effectively manage patients over an episode of care Expectation of post-acute care s contribution to reduced spending under the ACO model Metrics to evaluate partner selection and on-going evaluation Mechanism to incentivize post-acute care providers Processes to effect clinical integration, care transitions, and evidence-based care delivery in multiple, disparate post-acute venues 27

28 Hospital ACOs are Increasingly Considering Continuing Care Networks ACOs HAVE BEGUN DEVELOPING CCNs TO BETTER MANAGE COST AND QUALITY OF CARE Current State Future State SNF Hospital A IRF LTACH HHA PAC: Post-Acute Care; LTACH: Long-Term Acute Care Hospital; IRF: Inpatient Rehabilitation Facility; SNF: Skilled Nursing Facility; HHA: Home Health Agency 28

29 What Will the Future Look Like? EXPERIENCE WITH ACOs WITH FORMALIZED PAC PARTNERSHIPS / CCNs HAVE SHOWN RESULTS New initiatives (e.g. disease-specific pathways, complex care management) Substantially lower SNF ALOS 15-25% Improved in-network compliance Improved transitions of care and information exchange Lower 30-day readmissions rate (and beyond) 29

30 What Do PAC Providers Have To Do? KEY CAPABILITIES FOR PAC IN CHANGING ENVIRONMENT: Foster Provider Relationships and Integration Ability to Measure and Analyze Performance Manage Clinical Care Based on Evidence Ability to Take and Manage Financial Risk Demonstrate Value and Quality 30

31 Discussion/ Q&A

32 Contact Information Ellen Lukens Senior Vice President (office) 32

33 Appendix

34 Appendix A: BPCI Model 1 Participants in New Jersey Organization Name Inspira Medical Center Elmer Inspira Medical Center Vineland Inspira Medical Center Woodbury Robert Wood Johnson University Hospital Robert Wood Johnson University Hospital Hamilton Robert Wood Johnson University Hospital Rahway Saint Clare's Hospital (Denville/Dover) Saint Peter's University Hospital St. Joseph's Regional Medical Center, St. Joseph's Wayne Hospital St. Mary's Hospital Passaic University Medical Center of Princeton at Plainsboro Name of Initiative Care Setting # of Phase 1 Conditions # of Phase 2 Conditions New Phase 2 Conditions Entered 1/1/15 BPCI Initiative: Model 1 STACH N/A N/A N/A BPCI Initiative: Model 1 STACH N/A N/A N/A BPCI Initiative: Model 1 STACH N/A N/A N/A BPCI Initiative: Model 1 STACH N/A N/A N/A BPCI Initiative: Model 1 STACH N/A N/A N/A BPCI Initiative: Model 1 STACH N/A N/A N/A BPCI Initiative: Model 1 STACH N/A N/A N/A BPCI Initiative: Model 1 STACH N/A N/A N/A BPCI Initiative: Model 1 STACH N/A N/A N/A BPCI Initiative: Model 1 STACH N/A N/A N/A BPCI Initiative: Model 1 STACH N/A N/A N/A 34

35 Appendix B: BPCI Model 2 Participants in NJ (A-M) Organization Name Name of Initiative Care Setting # of Phase 1 Conditions # of Phase 2 Conditions New Phase 2 Conditions Entered 1/1/15 Atlantic Shore Orthopaedic Associates, LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Bayshore Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Cardiovascular Associates Of The Delaware Valley,P A BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Clara Maass Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Cogent Healthcare Of New Jersey, P.C. BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Columbia Emergency Medical Associates PLLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Community Emc LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Community Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Critical Care Physicians Of New Jersey, Pc BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Emc LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Emergency Medical Associates Chs LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Emergency Medical Associates Of Rhode Island Pc BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Emergency Medical Association Of New York Pc BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Emergency Medical Association Sound Shore PLLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Emergency Medical Association Westchester PLLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Emo Medical Care, LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Emo Medical Care, LLC Dba Emedical Offices BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Exigence Medical Of New York PLLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Garden State Orthopaedic Associates, P.A BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Hospitalists Emo, LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Ima Post Acute Care Physicians LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Inpatient Medical Associates Of New York PLLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Inpatient Medical Associates Of Passaic LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Kimball Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Kingston Emergency Medical Associates PLLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Liberty Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Lumberton Emergency Medical Associates Pc BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 35

36 Appendix B: BPCI Model 2 Participants in NJ (N-I) Organization Name Name of Initiative Care Setting # of Phase 1 Conditions # of Phase 2 Conditions New Phase 2 Conditions Entered 1/1/15 Manning Emergency Medical Associates PLLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Milford Urgent Care Associates PLLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Monmouth Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Morristown Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Newton Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Newton Emo LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Northern Westchester Emergency Medical Associates PLLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Nyack Emergency Medical Association PLLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Pulmonary And Sleep Associates Of South Jersey, LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Rahway Emergency Medical Associates, LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Reconstructive Orthopedics, Pa BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Richmond Emergency Medical Association, PLLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Saint Barnabas Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Somerset Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Union Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 University Orthopaedic Associates BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Wayne Emergency Medical Associates LLC BPCI Initiative: Model 2 PGP 48 0 Only in Phase 1 Atlanticare Regional Medical Center, Inc BPCI Initiative: Model 2 STACH 48 0 Only in Phase 1 Bayonne Medical Center BPCI Initiative: Model 2 STACH 46 2 Yes Christ Hospital BPCI Initiative: Model 2 STACH 46 2 Yes Hackensack University Medical Center BPCI Initiative: Model 2 STACH Yes Hoboken University Medical Center BPCI Initiative: Model 2 STACH 46 2 Yes Holy Name Medical Center BPCI Initiative: Model 2 STACH 47 1 No Hunterdon Medical Center BPCI Initiative: Model 2 STACH 48 0 Only in Phase 1 Inspira Medical Center Woodbury, Inc. BPCI Initiative: Model 2 STACH 3 0 Only in Phase 1 Inspira Medical Centers, Inc. (D/B/A Inspira Medical Center Elmer) BPCI Initiative: Model 2 STACH 3 0 Only in Phase 1 Inspira Medical Centers, Inc. (D/B/A Inspira Medical Center Vineland) BPCI Initiative: Model 2 STACH 3 0 Only in Phase 1 36

37 Appendix B: BPCI Model 2 Participants in NJ (J-Z) Organization Name Name of Initiative Care Setting # of Phase 1 Conditions # of Phase 2 Conditions New Phase 2 Conditions Entered 1/1/15 Jersey City Medical Center BPCI Initiative: Model 2 STACH No Lourdes Medical Center Burlington County BPCI Initiative: Model 2 STACH 48 0 Only in Phase 1 Lourdes Medical Center Burlington County BPCI Initiative: Model 2 STACH 48 0 Only in Phase 1 Morristown Medical Center BPCI Initiative: Model 2 STACH 48 0 Only in Phase 1 Mountainside Hospital BPCI Initiative: Model 2 STACH No Newton Medical Center BPCI Initiative: Model 2 STACH 48 0 Only in Phase 1 Our Lady Of Lourdes Medical Center BPCI Initiative: Model 2 STACH 0 8 No Our Lady Of Lourdes Medical Center BPCI Initiative: Model 2 STACH 40 0 Only in Phase 1 Overlook Medical Center BPCI Initiative: Model 2 STACH 48 0 Only in Phase 1 Pascack Valley Health System LLC BPCI Initiative: Model 2 STACH 48 0 Only in Phase 1 St Joseph'S Regional Medical Center BPCI Initiative: Model 2 STACH Yes St. Francis Medical Center BPCI Initiative: Model 2 STACH 48 0 Only in Phase 1 St. Luke'S Hospital-Warren Campus BPCI Initiative: Model 2 STACH No St. Michael'S Medical Center BPCI Initiative: Model 2 STACH 48 0 Only in Phase 1 The Memorial Hospital Of Salem County BPCI Initiative: Model 2 STACH 48 0 Only in Phase 1 The Valley Hospital BPCI Initiative: Model 2 STACH No Virtua? West Jersey Health System, Inc BPCI Initiative: Model 2 STACH 1 0 Only in Phase 1 Virtua West Jersey Health System Inc BPCI Initiative: Model 2 STACH 1 0 Only in Phase 1 37

38 Appendix C: BPCI Model 3 Participants in NJ (#) Organization Name Name of Initiative Care Setting # of Phase 1 Conditions # of Phase 2 Conditions New Phase 2 Conditions Entered 1/1/ Sunset Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Saddle River Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Route 72 West Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Woodland Avenue Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Lamberts Mill Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Wynwood Drive Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase 1 2 Deer Park Drive Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase 1 20 Summit Street Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Reynolds Avenue Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase White Horse Mercerville Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Rancocas Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase 1 25 East Lindsley Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Evesham Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Red School Lane Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Applegarth Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase 1 3 Industrial Way East Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Evesham Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Franklin Turnpike Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Grand Avenue Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Red School Lane Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase North Park Drive Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Ridge Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase 1 54 Sharp Street Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase State Highway 34 Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Town Bank Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase 1 77 Madison Avenue Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase 1 84 Cold Hill Road Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase Wilbur Avenue Operations LLC BPCI Initiative: Model 3 SNF 48 0 Only in Phase 1 Abingdon Care And Rehabilitation Center BPCI Initiative: Model 3 SNF 48 0 Only in Phase 1 Abingdon Care And Rehabilitation Center BPCI Initiative: Model 3 SNF 48 0 Only in Phase 1 38

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