CMS released important updates for Model Year 7 of Bundled Payments for Care Improvement Advanced. Providers who applied and have been accepted into the third cohort will soon begin the baseline evaluation and episode selection process. In this blog, we’ll cover important upcoming BPCIA dates and what you need to know now and for the future. Important upcoming CMS BPCIA dates Here are important BPCIA dates you’ll want on your radar in the coming months: September 2023 : At the beginning of the month, CMS will upload preliminary BPCIA Model Year 7 episode target prices and baseline episode and claims data on the CMS Enterprise Portal. As a provider, you will need to use these data to evaluate which clinical episode service line groups you want to participate in during the new model year. Dec. 4, 2023 : Providers who choose to move forward in the model have until this date to submit their MY7 Participation Agreement and Participant Profile, which will indicate selected episode initiators...

The healthcare industry has seen considerable government policy changes over the years that significantly impact patients and providers alike. A recent proposed change is the Medicare Outpatient Prospective Payment System Remedy for 340B Drug Payment Policy proposed rule . Issued in response to the U.S. Supreme Court’s decision on American Hospital Association v. Becerra , the 340B proposed remedy rule would provide 340B hospitals that were improperly underpaid during calendar years 2018 through 2022 with a one-time lump sum payment. This blog post will delve into the proposed rule, the potential impact of changes that providers could face and what 340B hospitals can expect in terms of remedy payments. How the 340B proposed rule changes would impact providers Payment reduction The proposed rule includes significant changes that would impact providers. First is the estimated annual payment reduction to offset the 3.19% rate increase in calendar year 2018. This proposed change would res...

DOH has released more details about actions hospitals must take under its Statewide Planning and Research Cooperative System injury, cause and place remediation project . The project was necessitated by a grant-funded study underway at DOH. SPARCS updated its edit rules to ensure injury, cause and place diagnosis codes between 2016 and 2023 are aligned to support the data integrity of the grant-funded study. As a result, New York state hospitals must resubmit inpatient and emergency department claims that fail these updated edit rules. Since the April 27 announcement of this project, HANYS has advocated on behalf of the state’s hospitals, bringing attention to the project’s workforce and financial implications. In addition, the DOH six-year data retention requirement and electronic health record changes have left some facilities lacking the data requested by the state. HANYS strongly encouraged SPARCS to enforce the new edit requirements only moving forward, to mitigate the challenges ...

Many CMS value-based care models seek to improve care coordination and reduce Medicare fee-for-service spending through episode-based payment and practice transformation. The agency’s new Enhancing Oncology Model applies these objectives to cancer care. There are many good reasons for any oncology practice to join EOM and improve the delivery of cancer care to its patients. But value-based care also raises the stakes. Participation alone doesn't guarantee success. Using analytics helps providers “trust but verify” ─ to not simply believe they are improving care quality and reducing costs, but know where they stand through tangible metrics. This blog post explores three best practices that help ingrain analytics in EOM practice, redesign and performance. How to anchor analytics for EOM performance 1. Estimate episode target prices for financial analyses Financial realities dictate whether practices join EOM, under what risk arrangement and if it's for the long term. Participati...

On June 8, CMS announced the new Making Care Primary Model that will run for 10.5 years, from July 1, 2024, to Dec. 31, 2034. To ensure you’re ready for the application process, this blog will explain what you need to know about MCP. What is Making Care Primary? The MCP model aims to make advanced primary care more available and sustainable. This model builds upon previous innovative primary care models over the past 10 years, including the Comprehensive Primary Care Initiative, Comprehensive Primary Care Initiative Plus and Primary Care First. State participation in MCP CMS announced that the MCP multi-state initiative will be tested under the Center for Medicare and Medicaid Innovation in eight states: New York, Massachusetts, New Jersey, North Carolina, Minnesota, Colorado, New Mexico and Washington. Based on what we know so far, let’s dive into the top five things you’ll need to know about this program. 1. MCP lasts 10.5 years The model duration (10.5 years) for the CMS MCP model...