Skip to main content

Five insights that improve BPCIA episode selection

Healthcare professional with stethoscope looking at graphs and data on a screen

CMS’ Bundled Payments for Care Improvement Advanced program will soon kick off a two-year program extension through 2025. Model Year 7 (Jan. 1 - Dec. 31, 2024) will be the first time that current participants (acute care hospitals and physician groups) can update their episode of care selections since 2020. MY7 is also only the second time since BPCIA launched (2018) that CMS will allow new providers to join. Applications were due May 31, 2023.

Whether you’re a new applicant or a current participant looking to update your episode selections to improve results, it’s never too early to prepare. BPCIA participants take on immediate full risk. This makes it critical to choose episodes that present the greatest savings, incentive and quality improvement opportunities.

Episode selection — An art and a science

For optimal BPCIA episode selection, providers must analyze their performance from the historic baseline period and design their clinical effectiveness strategies accordingly. It’s important to ask questions in five key areas: clinical buy-in, sufficient volume, actionable cost, manageable readmissions and achievable targets.

  1. Ongoing clinical buy-in

Even long-time BPCIA participants must ensure their clinicians stay engaged, especially if they plan to alter episode bundles. As noted by Alyssa Dahl, DataGen’s senior director, advanced analytics, “Stakeholders must be willing to do the hard work to improve care coordination, identify preferred networks and manage the process through completion.”

Key questions to support buy-in:

  • Have you identified a physician champion (existing or new)?
  • Have you educated your staff about BPCIA and your program goals?
  • Have you leveraged practice transformation wins from across your organization?
  1. Sufficient episode volume

To succeed in BPCIA, participants must have sufficient episode volume — at least 100 episodes annually. Sufficient episode volume helps reduce random cost variation and improves clinical intervention assessment. Providers must plan for the varying levels of cost variation inherent in different types of episodes.

Key questions regarding episode volume:

  • Has your episode volume significantly changed over time?
  • Is your variance to the target price heavily skewed by outlier episodes?
  • Can your organization sustain participation if performance fluctuates?
  1. Actionable cost

Care management teams must be able to target enough actionable costs to generate savings above the BPCIA program discount. Actionable costs are all payments made by Medicare to providers during the post-anchor period of the episode, excluding professional services. DataGen recommends actionable costs account for at least 50% of the overall episode spend.

Key questions regarding actionable costs:

  • What strategies can be used to reduce costs for this episode type?
  • Are your episodes using appropriate settings for post-acute care?
  • Do you understand what is driving your highest post-discharge costs?
  1. Comprehensive readmission strategy

BPCIA participants must have a readmissions management program to better coordinate patient care and help reduce overall episode costs. Knowing when readmissions occur, from what post-acute care setting and for which diagnostic reasons can help inform a participant’s implementation strategy. 

Key questions about readmissions:

  • What is an achievable readmission rate for each episode category?
  • Do current referral patterns contribute to excess costs?
  • Have you built a network of trusted, high-quality, post-acute care partners?
  1. Advantageous target prices

Providers considering BPCIA participation must determine if the preliminary target price for an episode category is achievable for their organization. BPCIA target prices take into account the provider’s historic efficiency, current case mix and peer group trends. 

Key questions when reviewing target prices:

  • How much actionable episode cost must be reduced to achieve the target price?
  • How does your utilization compare to national, regional and high performance benchmarks?
  • Do you expect your episode case mix to be different in the performance period?

The right questions provide the right answers

Every few months, providers should ask themselves the questions above, including the most important one: Has my hospital or physician group put itself at risk for the right reasons?

DataGen can help. Reach out today for baseline data analysis and consultation that can help you optimize episode selection and BPCIA performance.

Labels:

Comments

Post a Comment

Popular posts from this blog

BPCI Advanced – take advantage of the model extension now

The Bundled Payment for Care Improvement (BPCI) Advanced Model is now open for applications until May 31, 2023. This model provides a unique opportunity to acute care hospitals and physician group practices who are looking to: evaluate their bundle performance; rejoin if they have previously dropped out due to being under a convener; or take advantage of the changes to the model. With a small window to sign the participation agreement, you’ll need experts to process data quickly and accurately for evaluation. BPCI Advanced Program Details The Centers for Medicare & Medicaid Services (CMS) announced in October 2022 that this program will extend from January 2024 to December 2025. Data used for evaluation will be taken from the baseline period between October 2018 and September 2022. A participation agreement will be sent out in September 2023 and needs to be signed by October 2023 in order to participate. Those who apply before the May 31 deadline will benefit
Read more

BPCI Advanced Model Extension

CMS recently made several major announcements about the Bundled Payments for Care Improvement Advanced Model.  The model, which was due to expire at the end of 2023 (Model Year 6), will be extended for an additional two years through Dec. 31, 2025.  New applications will be accepted in 2023 for the two-year extension. Participants still active in Model Year 6 can continue without reapplying by signing an amended and restated participation agreement for Model Year 7.  New methodological changes will be implemented for Model Year 6, which starts on Jan. 1, 2023. Methodological changes include that: the CMS Discount Factor for medical clinical episodes will be reduced from 3% to 2%;  the Peer Group Trend Factor Adjustment cap for all clinical episodes will be reduced from 10% to 5%; the Major Joint Replacement of the Upper Extremity clinical episode category will become a multi-setting episode category by allowing episodes to be triggered when the procedure is performed in the hospital ou
Post a Comment
Read more

You’ve been accepted to the Enhancing Oncology Model. Now what?

The Centers for Medicare and Medicaid Services Innovation Center recently announced approved applicants for the new Enhancing Oncology Model. If your facility has been selected by CMS, are you still weighing your options during the current baseline evaluation period?  Two deciding factors may include the program data that CMS provides and whether EOM is enough of an improvement over the prior Oncology Care Model to make your investment worthwhile. Another factor to consider: Will you have the resources in place to conduct a baseline evaluation before EOM’s program start on July 1, 2023? How EOM differs from OCM EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment. It includes three major updates: Fewer cancer types. Compared with OCM’s 21, EOM will be limited to seven common cancer types: breast, prostate, lung, small intestine/colorectal, multiple myeloma, lymphoma and chronic le
Post a Comment
Read more