News | Bundled Payment

CMS identifies keys to success in bundled payment as BPCI-A deadline looms

News | Bundled Payment

CMS identifies keys to success in bundled payment as BPCI-A deadline looms

  • Providers wishing to join the voluntary BPCI-A program have until June 24 to apply for the program’s final open-enrollment period.
  • Some hospitals that have earned bonus payments under the mandatory CJR bundles have not collected the payments.
  • The administration is considering extending the CJR program, which has only one year left.

Ahead of next week’s deadline for providers to join the largest voluntary bundled payment program, the agency in charge of the program identified lessons learned by successful participants.

Christina Ritter, PhD, director of the patient care models group for the Centers for Medicare & Medicaid Services (CMS), spoke at a healthcare industry gathering in Washington, D.C., about what has set apart successful participants during the first year and half of the five-year Bundled Payments for Care Improvement Advanced (BPCI-A) model.

  • Approaches of successful BPCI-A providers include:
  •  Maximizing use of the available CMS data
  • Collaborating with post-acute care providers
  • Requiring standards of care throughout the organization, not just at facilities that are participating in BPCI-A
  • Using clinical coordinators
  • Having committed leadership
  • Enrolling in a variety of clinical episodes
  • Investing the time to make needed changes

Ritter said the data aspect was “huge” in impacting success and was driven by providers’ ability to find data patterns that usually are not visible to fee-for-service providers.

“Obviously, conveners help a lot in that space by providing that analysis, if you’re not able to do that on your own,” Ritter said, referring to the 834 conveners (hospitals or risk-bearing partner entities) that coordinate the participation of other providers in BPCI-A. 

Providers wishing to join BPCI-A have until June 24 to apply for the third year of the program, which starts Jan. 1, 2020.

CJR outcomes also show positive trends

Another large CMS bundled payment program, the Comprehensive Care for Joint Replacement (CJR) model, is in its fourth year and also has generated positive early results, Ritter said at the National Bundled Payment Summit.

CMS has fully analyzed only first-year results, but they indicated that a mandatory model — a key differentiating feature of CJR from the voluntary BPCI models — can achieve savings while maintaining quality.

Outcomes include:

  • Reducing discharges to inpatient rehabilitation facilities (IRFs)
  •  Increasing discharges to home healthcare
  • Substituting skilled nursing facility (SNF) care for IRF care among fracture patients
  • Cutting days spent in SNFs
  •  Leaving unaffected readmission rates, ED visits and mortality

The administration has proposed extending CJR and undertaking revisions of target prices, which are calculated at 100% of regional prices. Second-year results are expected to be released soon, Ritter said.

“CJR was put into place a while ago, and to the extent we want to think about how to make that applicable going forward, we have to look at how that pricing structure happened relative to what we know now under BPCI-A,” Ritter said.

Some CJR payments go unclaimed

Ritter revealed that “a handful of hospitals” have garnered Medicare bonus payments under the CJR program but left those funds unclaimed.

“They saved money, they didn’t know it, they still haven’t claimed it, and I guess that’s part of being in a mandatory model,” Ritter said. “We continue to try to reach out to them.”

The oversight likely happened because those hospitals perform relatively few qualifying procedures and so decided not to allocate the resources necessary to track their progress under the program.

Patient-reported outcomes eventually will affect payments

CMS continues to collect patient-reported outcomes for participants in CJR. “We don’t yet feel like we’re in a position to make payment based on those patient-reported outcomes, but we continue to prioritize collecting them and they will indeed be an important part of data collection for models going forward,” Ritter said.

About the Authors

Rich Daly, HFMA senior writer/editor

is based in the Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

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