Participation in Model Year 7 launched on Jan. 1, 2024, with the first few months being a critical time for providers. New Bundled Payments for Care Improvement Advanced Model (BPCIA) participants got their footing, and continuing participants were able to change their clinical episode service line groups for the first time since 2020.  If you’re a provider participating in this model, read on for a BPCIA refresher and four fast facts for starting MY7 right. We’ll also cover core analytics activities to support your clinical and operational success.   4 Fast facts on BPCIA Model Year 7  1.   Focus on clinical episodes and episode volume  Before MY7 began, providers used historic baseline data provided by CMS to evaluate which CESLGs they would go at risk for, ensuring there would be sufficient episode volume. Large episode volume (100 episodes/year or more) reduces random variation and helps protect providers from financial risk associated with outlier...

Third quarter Statewide Planning and Research Cooperative System deadlines are rapidly approaching! It’s more important than ever for hospitals to focus on meeting DOH requirements for SPARCS compliance.  In this blog, we'll help you understand what you need to focus on right now to ensure you meet New York state SPARCS data submission deadlines. Read on to learn which data will soon be delinquent, what’s at risk and which target dates hospitals must hit next.  March and April SPARCS compliance deadlines  A hospital’s quarterly SPARCS submission isn’t “done” until it is submitted error-free. DOH publishes SPARCS Audit and SPARCS Compliance Reports to help hospitals keep track. Weekly audit reports document the number of discharge claims a facility submits to the SPARCS data warehouse versus those accepted. Claims with errors are rejected.   The state monitors error resolution through monthly compliance reports. Hospitals with outstanding SPARCS errors receive three ...

Federal legislative and regulatory measures enacted since 2010 have fundamentally altered Medicare provider payments — and consequently, the operational landscape for hospitals across the United States. As part of an ongoing dialogue on health policy reform and fiscal strategy, it's crucial for hospital administrators and healthcare professionals to understand the breadth and depth of these payment adjustments.  That's why DataGen released the Enacted Medicare Cuts Analysis as part of our legislative analyses suite, which is intended for advocacy purposes only.  We looked at the extent to which hospitals have been impacted by existing Medicare provider payment cuts that Congress has enacted to achieve Medicare payment policy and/or long-term deficit reduction goals. The impacts shown in this analysis include the major cuts enacted since 2010.  In this blog, we'll cover the enacted legislative cuts, enacted regulatory cuts and quality programs analyzed in the Enacted Medi...