Starting in 2008 CMS started increased bundling for APCs. At first this was simply at the procedure level generally using SI=”N” in order to effect the bundling. Then Composite APCs were developed and the evolution continued on to comprehensive APCs or C-APCs. C-APCs represent significant bundling using the “J1” and “J2” status indicators. For 2016 and 2017, CMS has moved rapidly to increase the
number of C-APCs and this trend is likely to continue. The basic philosophy is that APCs in general represent a prospective payment system in which there should be significant bundling similar to that which is found in DRGs. Historically, the precursor to APCs was APGs (Ambulatory Patient Groups) in which there was significant bundling through significant procedure consolidation. With the rapid deployment of many C-APCs, hospitals have a very difficult time assessing the financial impact that C-APCs engender. Dr. Duane Abbey will review and clarify the various bundling techniques, discuss status indicators for APC grouping processes, discuss C-APCs and discuss additional steps to mitigate the impact of C-APCs.