Posted by Signature Care Management Team on Thursday, April 25, 2019 in Blog
The much-anticipated season premiere of Game of Thrones (GOT) premiered this month and it set the stage for what is likely to be six episodes of excellent television. Similar to GOT, the Medicare value-based care pilot programs have kept us on the edge of our seats and we have experienced some twists and turns along the way. Bundled Payment for Care Improvement (BPCI)-Advanced is one of several voluntary Medicare value-based care initiatives. Effective October of last year, and ultimately running through 2023, it is the third generation of similar programs pioneered by CMS, and the most inclusive in terms of the breadth of clinical episodes.
There was a recent article about the trepidation and skepticism many feel about participating in Centers for Medicare and Medicaid Services (CMS) pilot programs due to financial uncertainty and program instability. In the quest to make our healthcare system better with BPCI-Advanced, CMS and participants have worked together in an iterative process with continuous feedback from participants to ensure the program works for providers and patients. Overall, the program has been a success in terms of improving care and reducing unnecessary cost, while generating significant ROI for participants.
In addition to taking a step in transitioning your business model to value-based care, there are three reasons to sign up for BPCI-Advanced:
1. Free Medicare Data
Organizations who sign up for BPCI-Advanced receive three years of free Medicare data for all relevant clinical episodes. This data includes line item cost data and patient detail for all services billed to Medicare within the 90-day clinical episode, including acute-care costs and post-acute care costs. Organizations also receive target prices at each hospital for every clinical episode.
2. Financial Opportunity
The data and financial opportunity are specific to your organization. If you have the volume and target prices that warrant success in Medicare bundles, that represents an excellent opportunity. If this is your first time participating in BPCI, there is the potential for significant financial returns to your practice and individual physicians, as well as improved outcomes and increased satisfaction for your patients.
CMS lifted the financial cap organizations can attain in the program, allowing financial savings to be distributed to the practice above and beyond the 50% individual physician Part B billings in order to cover direct costs. This allows a practice to make the FTE, technology, and other investments necessary to best perform in value-based programs.
If the Medicare volume and target prices are not in your favor, organizations who do not have financial opportunity in Medicare bundles use their Medicare data set to pivot towards a commercial bundled payment. This free information is extremely valuable when negotiating with payers in a bundled payment or value-based care contract.
3. Learn About Value-Based Care and Bundled Payments
Even if your organization does not have enough Medicare case volume to participate, it is a worthwhile exercise to review the data, gain understanding about important data elements, clinical cost drivers that providers can control and manage v. clinical cost drivers that are completely of out the control of the provider. In addition, this sign up period may be the last time organizations can participate in a model as a voluntary participant. Secretary of Health and Human Services Alex Azar has stated value-based care is a top priority and more mandatory models will be implemented.
The choice is yours. Partner with us, and utilize our proven success in value-based care models, data analytics, and care management expertise to help you achieve financial and clinical success.
Contact us for free Medicare data and a no cost, no obligation financial opportunity analysis for BPCI-Advanced.
Ann Conrath, Director of Business Development
Signature Care Management
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