Thursday, April 25, 2019 | Ginger Biesbrock
Bundled Payment Care Initiative-Advanced launched in October 2018. MedAxiom had several members that took the plunge into this program in several different CV bundles including PCI, AMI, HF, Arrhythmia, Pacemaker and CABG. Now that CMS has opened the application period for Cohort 2, there are lessons to be learned from those that have come before us. During the MedAxiom Spring CV Transforum meeting, several of the programs came together to answer questions and provide insights on successes and challenges. I thought it valuable to provide a recap.
For a brief review, BPCI-A is a CMS-sponsored bundle payment program where Medicare, based on historical spending, risk adjustment, organizational characteristics, assigns a target price to a 90-day episode of care that starts with a trigger event – either a procedure or a hospitalization. The CPT code of the procedure or DRG of the hospitalization triggers the episode. The utilization costs for the following 90 days are tracked; if the costs are under the target price the episode owner is allowed to share in the savings, and if the costs are higher there is a penalty assigned.
The initial cohort had the option at the end of February to drop bundles or even the entire program if they were not performing favorably. The good news is that almost all of the MedAxiom members that signed up stayed in the program, although most did drop at least one bundle.
The overall consensus from the programs that we have talked to have been favorable. However, all noted key lessons that they have learned through the experience.
It is exciting to see best practices emerge as healthcare organizations begin to learn how to better care for their patients throughout an entire episode of care. The game changes significantly when you become financially responsible for care provided beyond the initial procedure or hospitalization. Data is so incredibly important to understand current state and opportunities for care improvement and financial savings. A partner to better understand the costs and targets is imperative. Most invaluable, is a partner that provides as close to real-time feedback as possible with insights into care opportunities. A clinical team that includes a physician champion and dedicated care manager are both identified as important best practices. Finally, access through 24/7 call support and same-day visits is required to avoid expensive ED hospitalizations and readmissions.
We are excited about the next open enrollment period. We know that our entire healthcare industry is moving towards value-based payment programs that require ownership of patients to a degree that we have not had to deal with before. BPCI-A is a great way to ‘dip your toe in the water’ and push to get your program moving in a more comprehensive care direction. The initial enrollment will provide you with historical utilization data to allow for a good understanding of the risk (either positive or negative) for your patients that would fall into the CV bundles. There is no long-term obligation with the initial enrollment. Once you have had an opportunity to review your risk, you then decide which bundles you want to commit to and move forward within the program. I encourage you all to start with getting your data to understand your opportunity, and begin to think about what is needed to be successful. Many of you may already find that you will be successful and with a few tweaks of your care team and clinical model, your long-term success will be ensured. We will be providing you with up-to-date information throughout the open enrollment period. Make sure you don’t miss this important opportunity.
Learn more about the next open enrollment period at medaxiom.com/bpci-advanced and join us at our upcoming webinars:
BPCI Advanced Open Enrollment: What you need to know
Tuesday, April 30, 2019, 1:00 pm
BPCI Advanced: What's New for Cohort 2?
Wednesday, May 8, 2019, 1:00 pm
BPCI Advanced: Insights and Lessons Learned from Cohort 1 CV Participants
Wednesday, May 22, 2019, 1:00 pm
Illustration: Lee Sauer
Ginger Biesbrock, PA-C, MPH, MPAS, AACC, is Executive Vice President, Care Transformation. She is a respected executive, provider and teacher with 20+ years of experience in the health care industry with a concentration in clinical care and operations. Before joining MedAxiom Consulting, Ginger was Director of Operations at West Michigan Heart, a 39 Physician practice with 24 mid-level provider. At West Michigan Heart, Ginger oversaw all operations for ambulatory services, tertiary care and rural health practices. Prior to that Ginger was the COO of the Cardiovascular Group at Centra-Health.
Her areas of consulting expertise include APP Utilization, Care Team Optimization and Transitions of Care.
To contact, email: email@example.com