EPM & BPCI Updates: What You Need to Know Now

Tuesday, September 5, 2017 | Joel Sauer, Dave Terry

 

As you are probably well aware, CMS recently proposed to cancel the mandatory EPM program and reduce the size of the CJR program. At the same time, CMS has indicated they will be replacing EPM and CJR with new voluntary bundle payment initiatives that will allow hospitals, specialists and post-acute providers to serve as Episode Initiators. Contrary to some in the industry, we view these as positive developments and wanted to share with you a few quick thoughts about them.      

To date, charting real progress toward improving care and reducing health care costs has been challenging, due to limited engagement and participation in the mandatory programs. Fortunately, in our experience, voluntary programs have generated significant interest and engagement among participants.

Last week we spoke to some of the team at CMS, and they reiterated their desire to proceed with the next generation of BPCI, a voluntary model. It seems likely they will have the rules out by mid-September with the goal of getting providers actively participating in the programs in 2018. They also indicated they’d introduce a new pricing model that encourages both efficient and higher-cost providers to participate—another good sign for current BPCI Episode Initiators. The new BPCI program will also provide many specialists their first opportunity to qualify for the Advanced Alternative Payment Models track under MACRA's Quality Payment Program, giving physicians the chance to earn an additional 5% bonus, and avoid downside risk and additional reporting requirements under MIPS.

One of our top goals is to keep you informed and help you succeed with CMS programs and initiatives that aim to improve care and reduce costs. As such, Archway Health and MedAxiom Consulting have partnered to make the design and implementation of bundled payment programs as simple as possible for the CV care community. Our team combines the expertise of CV consultants, proven healthcare operators, big data analysts, and technology entrepreneurs. The Archway platform currently powers the bundled payment programs for more than 100 providers with over $100 million in annual revenue.

Please know that we will continue to provide you with updates and offer our expertise to navigate these complex issues. We encourage you to learn more via the links below:

• Archway Blog, “Cancellation of Mandatory Bundles Paves the Way for Voluntary Success”
• MedAxiom Blog, “My Ten Wishes for BPCI 2.0”
• McKnight’s, “CMS proposes cancelling cardiac, orthopedic bundled payment models”
• MedAxiom’s Bundled Payments Resource Page
• Healthcare Dive, “Bundled Payment Proposals Include Canceled, Scaled-Back Programs”
• Archway Blog, “BPCI Scorecard Provides Snapshot of Potential Savings”

The latest information on and detailed analysis of CMS rules will be discussed at the CV Transforum Fall’17 conference, October 12-14, in Dana Point, CA. Join the nation’s top CV thought leaders and decision makers at this important, CV-focused event http://cvtransforum.com/.

As always, please contact us if you have any questions or feedback.

 

Joel Sauer, Vice President, MedAxiom Consulting	Dave Terry, Founder and CEO, Archway Health