On January 9, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced a new, voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). BPCI Advanced is the latest effort from CMS aimed at shifting a greater proportion of fee-for-service reimbursement into value-based care models that more directly tie payment to cost and quality outcomes. The model is designed to fundamentally bend the cost curve for a given episode of care, ensure greater coordination across providers and healthcare settings and provide Medicare patients with higher-quality results.
As the name would suggest, BPCI Advanced builds on the earlier BPCI model, but differs in some important ways (see table), including new outpatient episodes for high-volume, high saving potential procedures, and a pathway to leverage bundled payments as part of a health system’s overall approach to two-sided, risk-based contracting.
*Source: Health Affairs
Advantages of Participation
Participants in BPCI Advanced can still participate in the Medicare Shared Savings and Next Gen ACO programs, making it an attractive add on to those who are already well down the path toward population health, without significant retooling. The advantage to adding on is that it can be helpful to bring specialists to the table, which could help organizers achieve even greater savings in the ACO programs as they expand into bundling for certain episodes.
BPCI Advanced qualifies as an advanced alternative payment model (APM) under the Medicare Access and Chip Reauthorization Act (MACRA) of 2015. Participants that pursue this approach will be eligible for a 5 percent bonus for professional fee payments, making it a valuable tool to assist health systems with physician network alignment.
Organizations that were subject to the mandatory roll out of the Comprehensive Joint Replacement or cardiac bundles have already invested time and money on their preparation. BPCI Advanced represents a key way to channel those investments into a new program that can help them realize ROI on their earlier work.
Bundled payments represent a very attractive and aligned financial model for bringing primary care, specialists and post-acute care together to optimize clinical and margin performance in value-based care. Provided the organization is ready, BPCI Advanced may be the ideal strategy for building enhanced, risk-based contracting skills that are increasingly in demand from commercial and public payers.
Participants in the BPCI Advanced program will be able to take advantage of a number of payment policy waivers that have traditionally hampered care coordination and quality, including:
- 3-Day Stay SNF Rule Waiver: This waiver allows for Medicare coverage for SNF care without a 3-day hospital stay. In other words, participants can discharge healthier patients to from acute to post-acute care faster, which greatly improved the hospital length of stay
- Telehealth Waiver: This waiver expands Medicare coverage for telehealth to include additional care settings (such as hospital at home care) in all geographic areas (i.e., not just rural areas).
- Post-Discharge Home Visit Waiver: This waiver permits Medicare coverage for a home visit after hospitalization without direct physician supervision, allowing health coaches or nurses to provide follow up services.
- Beneficiary Incentive Waiver: Under this waiver, participants may offer “in-kind” items or services that are not Medicare-covered items or services to a beneficiary that is related to the clinical episode (e.g., transportation, equipment) to incent better outcomes and stickiness to in-network providers in the bundle.
Why You Should Apply by March 12
With the surge in interest around bundled payment models since the BPCI Advanced launch, providers should act quickly to complete the non-binding process of applying to the program. This allows leaders to request data from CMS and “reserve” a spot within program, which is especially important because this is the only open application window until 2020. With the deadline looming (March 12, 2018), leaders should take advantage of this opportunity to fill out the brief application — providing access to critical data that can help leaders assess the opportunity to participate.
How Premier Can Help
Premier has partnered with hundreds of hospitals, physician groups and other providers to help them achieve the financial benefits of being in one of CMS’ bundled payment models, while simultaneously improving the quality and patient outcomes. In this work, we help our members navigate their efforts on optimizing processes and operations with the highest variation, including quality and efficiency improvements in the post-acute care setting. Our unique collaborative model also shortens the learning curve, providing best practices, advocacy services and a robust and dynamic claims processing tool so that members can get to savings and top performance faster.
Premier is offering support for our members on the BPCI Advanced application process at no additional cost. Once a member has applied, providers can also access our Episode Opportunity Analysis (EOA) at no additional cost to identify the magnitude of the opportunity on BPCI Advanced inpatient and outpatient clinical episodes in advance of your baseline data. We help providers evaluate their strengths and weaknesses in each clinical episode and drive constant improvement. As always, Premier stands side-by-side with providers to make educated and informed, data-driven decisions to generate additional savings.
I’m a finance and strategy specialists that grew up in a military family overseas and in the States. I lead Premier’s Bundled Payment Collaborative, providing education, episode development, care re-design, quality and other measurement, cost reduction identification, and physician alignment/gain sharing insights. When I’m not working, you’ll find me taking part in adventurous activities with my four kids. Connect with me on LinkedIn.
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