BPCI Advanced Participation Next Steps: Lay the Foundation for Success

If you successfully submitted your application and data request for CMS’s Bundled Payment for Care Improvement Advanced (BPCI-A) then you, like many across the US health care system, gave a sigh of relief when the clock struck midnight on June 24.

That relief, however, will be brief.

Before Medicare releases requested historical claims data (expected in September), it is essential that hospitals begin to assess, evaluate, build, and refine their various systems and assets to prepare for BPCI-A. Below are the key steps institutions should be taking to lay the foundation for achievement of clinical and financial success in the program.

1. Assess your data analytics capabilities for reviewing your historical claims data.

After the data are released, you will only have 60 days to review to determine Episode selection, so having the proper capabilities will allow you to quickly and thoroughly access and process the historical claims data to inform your Episode selection.

We always recommend evaluating the data on your own, even if you are working with a convener, as you may not get all the details and analyses you feel are necessary from your convener, and/or your convener’s timing might not be in sync with your needs.

If you are unsure what analytics capabilities you need, jump to the link below to connect with an experienced Sg2 expert who can educate you on what kind of analytic capabilities are necessary for your organization, as well as how Sg2 can quickly process the baseline data files for you.

2. Use benchmarking capabilities to inform and understand post-acute care utilization.

This is essential because unlike legacy BPCI, participants in BPCI-A are competing not only against their own historical utilization, but against regional peers, risk adjustment factors and other comparisons as well. Having an appropriate benchmark will help you determine where you need to take action, as well as where your opportunities lie.

When comparing an organization’s performance against the Sg2 benchmark database for an orthopedic bundle, a clinical episode looked mundane, as the historical spend is equal to the benchmark target price (this is the target to beat for bonus payments under the program). However, further analysis showed significant opportunity if slight adjustments were made to the post-acute care setting, along with a modest length of stay reduction in skilled nursing facilities. Upon seeing this data, the orthopedic surgeons unilaterally agreed care redesign initiatives could be put in practice almost immediately, which would result in significant financial upside.

Note: Sample data are illustrated in this manner for demonstration purposes only and may not reflect exact deliverables.

3. Prepare your organization’s clinical infrastructure.

A strong infrastructure is necessary to implement, oversee and manage the bundled payment initiative, including:

  • Governance and support structure: consider service line focused committees that include key physicians, care management, finance/IT and service line leadership.
  • Ongoing data analytics measurement: monthly reporting and reconciliation every 6 months are required.
  • Specialized care navigation: follow high- and intermediate-risk patients through a 90-day care plan.
  • Narrow post-acute care provider networks supportive of your quality and utilization requirements: quarterly meetings with post-acute providers to share their performance has proven effective.

Sg2 designed an effective governance structure for one of our members, shown below, enabling them to successfully vet participation in a program and a care redesign plan.

Note: Sample data are illustrated in this manner for demonstration purposes only and may not reflect exact deliverables.

4. Begin informative discussions with the necessary physicians and other clinicians.

Ensure they understand “business as usual” is not enough to succeed during this sea change in reimbursement mechanisms.

Next, educate yourself on the incentive models, including those for employed physicians, that can help align interests and efforts.

Finally, educating your medical staff is also of paramount importance before committing to the program.

The Time Is Now

In general, take advantage of the time you have over the next 2 months. As previously mentioned, the timeline for Episode selection—which occurs once the historical claims data are made available—will be short. Furthermore, it is important to note that improper Episode selection could prove to be financially troublesome, as you will be committed to the episode you select for at least one year.

If you want to be prepared to succeed—not just participate—in BPCI-A, don’t wait: contact Sg2 today. Ask our experts your bundled payment questions via email. We are the nation’s foremost authority on bundled payments and the complex requirements necessary to make them successful. Our team of principals has more than 25 years of experience working with CMS and bundled payments, harkening back to Medicare’s initial foray into this alternative reimbursement mechanism in 1991, and encompassing every initiative since.

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