An Ensocare "Deep Dive Series" - Part III: Factors to Consider When Undertaking BPCI Advanced
Other Videos in this Series:
Part I: View "What is BPCI Advanced"
Part II: View "Recapping a Year of Change"
I’m Justine Olsen and I’m a Healthcare Strategy Analyst.
Undertaking a program like BPCI Advanced should not be taken lightly. It has some very exciting opportunities, but, from a planning perspective, you really need to make sure that you’re ready.
Some factors to consider include your experience with taking on downside risk-based agreements. So, again, the opportunity to lose money if you do not perform accordingly. Within a bundled payment program like BPCI Advanced, program participants identify an episode of care that they’re interested in managing total cost of care around.
And so, with that in mind, really a baseline expectation is, one, you understand the total cost of care for that particular clinical episode. We know that CMS will be releasing targets so, essentially, how much money they think an episode of care should cost according to your site, and, if you exceed those, you’re on the hook for the payment. You have to reimburse CMS for that, so understanding that total cost of care will be imperative.
Another component of that is, what is your organization’s experience in terms of quality improvement programs? Do you have experience in implementing programs like care variation reduction initiatives or general population health programs? And the reason that is important is, first, we know quality is taken into account with a program like BPCI Advanced, but we also know that implementing quality initiatives does include both the quality of care as well as help to reduce the total cost of care, so that’s something important to keep in mind.
Additionally, the way that BPCI works is that program participants are evaluated over a 90 day period for an episode of care. We’re assuming that, when you select an episode of care, the patient themselves, the Medicare beneficiary, is not going to be in the acute care facility for that whole 90 days. You have a problem if that’s the case. What that will require is additional coordination with post-acute care facilities to make sure that all of the follow-up care that the patient is receiving in the aftermath of a service is being coordinated, is on track and that they’re receiving all of the services they need to be as well as they can possibly.
And so when you’re determining whether to participate in such a model, it’s really important to evaluate what relationships have you developed with these post-acute networks and how might you design any sort of contract arrangement with them to make sure that they, through participation in the bundle, are also benefiting from any savings.
And then, finally, from a quality payment program or MACRA perspective, if you’re looking at BPCI Advanced as an opportunity to participate and take advantage of that Advanced APM status, it’s really, really important that you look at your patient volumes for the clinical episode of care that you’re considering. Just because a program like BPCI Advanced meets all of the requirements as an Advanced APM, it doesn’t mean that you as a provider or you as an organization will meet the volume thresholds to receive that bonus and then, most importantly, be exempt from MIPS. When you’re evaluating what clinical episodes you might participate in, it’s really, really crucial that you understand that you do have the patient volume to support meeting that expectation.