Healthcare providers are taking steps to prepare for CMS' new voluntary bundled payment program, the Bundled Payments for Care Improvement Advanced Model.
The program, announced on Jan. 9, will initially include 32 clinical episodes, and will qualify as an advanced alternative payment model under the Medicare Access and CHIP Reauthorization Act's Quality Payment Program. The American Hospital Association asked CMS to provide detailed information about the model by March 1, and extend the application deadline from March 12 to April 16. However, the original deadline remains in place.
In light of this looming deadline, Win Whitcomb, MD, CMO of Remedy Partners, a bundled payment company managing 484,000 cumulative BPCI episodes and $12.1 billion cumulative medical spend to date, recently shared how he sees providers preparing for BPCI Advanced.
1. Participation. Initially, providers are deciding whether they want to participate in the program. This involves educating themselves about how BPCI Advanced can potentially move their organization's strategic objectives forward, according to Dr. Whitcomb. "A lot [of] providers are undergoing a discovery process," he says. "We're spending time with potential partners one on one, and doing educational forums like webinars and written pieces to get the word out about how BPCI [Advanced] can advance an organization's goal to shift spending from volume to value."
2. Financial risk. Physician groups especially are thinking about financial risk as they decide whether to participate. Dr. Whitcomb says some physician groups may not fully understand what taking risk in BPCI Advanced entails if their current financial risk is only in a small targeted practice or capitation. Therefore, groups want to ensure they are able to remain solvent if they do participate. "Physician groups tend to have small operating margins, so if they don't take risk wisely, it certainly can be an existential threat to the practice," he says. "So, they want to understand how risk works and how they can mitigate it and manage it."
2. Other value-based care programs. Hospitals are looking at financial risk as well, but also examining how BPCI Advanced fits in with other value-based programs they're already participating in, says Dr. Whitcomb. For example, hospitals seek to understand how BPCI Advanced would stand with CMS' Hospital Value-based Purchasing, Hospital Readmissions Reduction and Hospital-Acquired Condition Reduction programs. Additionally, hospitals, as well as physician groups, seek to understand how BPCI Advanced will work alongside their ACO, if they have one, says Dr. Whitcomb. They want to ensure BPCI Advanced doesn't work at cross purposes with their ACO. "We see tremendous synergy between ACOs and this particular program because ACOs tend to engage with primary care doctors whereas BPCI Advanced is a great opportunity for organizations to engage their specialists and hospital-based physicians," he says.
3. Pricing. Dr. Whitcomb also sees providers examining what their organization's pricing looks like for the 32 clinical episodes in BPCI Advanced. This means they will be getting their claims data from CMS and analyzing it to identify potential opportunities across the 32 bundles. In other words, "where do our opportunities lie in terms of participating in selected bundles and how would we understand what an opportunity really is and how to uncover that," he says. "Things like how are we doing with readmissions, how are we utilizing post-acute facilities, how do we look in terms of complications? As an example, how is our episodic performance for elective orthopedic surgery or nonelective bundles, and would that represent an opportunity for savings in BPCI Advanced?"
4. Quality measures. Providers want to know if they are able to improve and perform against quality measures in BPCI Advanced, according to Dr. Whitcomb. Therefore, he says they're examining these measures, including readmissions and complications, to see how they're doing currently.
5. Skilled nursing facility networks. Healthcare organizations are evaluating their skilled nursing facility networks to determine if they would perform well under BPCI Advanced, according to Dr. Whitcomb. "Networks of high performing SNFs are vital to the success of bundled payment programs. Referring to facilities with demonstrated performance on quality, readmissions, efficiency and patient experience measures can mean the difference between success and failure," he says. He adds many organizations face difficulties in establishing criteria for network inclusion and then working to create and update the network over time.
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