The Centers for Medicare & Medicaid Services (CMS) recently launched its newest bundled payment model, the voluntary Bundled Payments for Care Improvement (BPCI) Advanced, and they are doing something unique in the healthcare industry – pleasing both clinicians and management.
“Volunteer bundles are a very attractive proposition for providers and health systems to generate outside revenue and simultaneously impact patient outcomes from beginning of care to the end of care,” said Saqib Akhter, CEO of Post Acute Analytics, a company that helps health systems and providers monitor their patients in real time outside their four walls.
“Bundles will finance the infrastructure to do what many physicians had been wanting to do from the beginning, which is they want to make sure that when patients are outside of their four walls they are getting better. Historically there hasn’t been a very good financing source for this. However, with bundles there is a clear opportunity for return. And the opportunity for return on investment is net positive from where they are today. So, not only does this help providers to finance infrastructure to do a better job taking care of patients, it also allows them to make more money. And the U.S. healthcare system wins because it takes unnecessary costs out of the system.”
The Trump administration made it clear that it was not a fan of mandatory bundled payment programs by canceling cardiac care bundles and substantially rolling back mandatory participation in the Comprehensive Care for Joint Replacement (CJR) program.
Yet, BPCI-Advanced shows that the administration and CMS still see the value in bundled payments. For good reason. Bundles have proven to be effective, especially for medical conditions where start and end of care can be measured. The Cleveland Clinic reviewed its participation in the CJR program and found:
- The average length of hospital stay was reduced from 3.4 days to between 2.67 and 3.01 days each quarter.
- 30-day readmissions decreased from 5 percent to between 1.6 percent and 2.7 percent each quarter.
- Discharge to home (with and without home healthcare) increased from 39 percent to a quarterly range of 68 percent to 75 percent.
- Patients who gave their hospital a nine or 10 rating increased from a baseline of 74 percent to between 78 percent and 88 percent each quarter.
Are you ready to reduce readmission rates? Click here to learn more about your opportunities to participate in BPCI-Advanced.
BPCI-Advanced includes 32 inpatient clinical episodes, with 29 in the inpatient setting and three in the outpatient setting (many of which focus on orthopedic and cardiac conditions). A welcome improvement over the preceding programs is that BPCI-Advanced qualifies as an advanced alternative payment model (APM) under the Medicare Access and Chip Reauthorization Act (MACRA). This allows participants to avoid many of the hassles associated with the Merit-Based Incentive Payment System (MIPS).
“With MACRA, physicians have to choose one of two paths,” said Akhter. “They can go down the MIPS path, which is loaded with reporting requirements, or they can focus on APM, which avoids the reporting requirements because physicians are taking direct risk on the total cost of care.
“What we are seeing is that, in the long term, it is more financially advantageous for a provider to be in APM instead of MIPS. With all the work that goes into succeeding in MIPS, providers are better off doing that work while generating upside revenue by participating in APM.
“By CMS ensuring that bundles can qualify for the APM track of MACRA, CMS is showing that it is serious about opening up attractive options for providers to manage overall patient quality and costs across specific episodes of care and the entire continuum of care.”
However, unlike past bundles where a provider’s risk was phased in over time, BPCI-Advanced payments are at risk from day one. That means providers need to be controlling cost and getting results immediately.
“Post Acute Analytics helps anyone signing up in bundles to generate upside revenue by decreasing the inefficiencies in post-acute care,” said Akhter. “We achieve this by focusing on four key areas.
“First, we run a historical performance analysis to discover the delta between what is being offered to a provider and how they have performed historically. If the delta is positive or near positive, it is a good indication that a provider can make an impact in BPCI-Advanced and make money. If it is significantly negative, we can help them see if there is a way they could drive impact to be successful in the bundles.
“Next, Post Acute Analytics provides an algorithm to recommend the right care pathway for each specific patient, so they know how long each patient should be in a post-acute setting including which setting is appropriate and what they need to achieve while there.
“Then, Post Acute Analytics creates a network scorecard that gives providers a picture of which post-acute providers are doing a good job taking care of their patients by diagnosis, i.e., their ortho patients versus cardiac patients versus their stroke patients, etc. That way providers can set up a high-performing post-acute network and ensure that patients are sent to the most appropriate post-acute provider.
“Finally, Post Acute Analytics provides real-time patient monitoring where providers receive real-time alerts when a patient is at risk for having a poor quality or cost outcome. This way providers can proactively intervene and do something about it before a high-cost, poor-outcome event occurs.”
To learn more about Post Acute Analytics and how its proven solution can help providers succeed with BPCI-Advanced, click here to schedule a personalized discussion.
