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BPCI Advanced: An Opportunity for Physician Leadership in Care Redesign

Friday, March 2, 2018   (0 Comments)
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By: Ann Conrath, MSW, LCSE, Account Manager, Signature Medical Group, Inc.

As the Bundled Payment for Care Improvement (BPCI) initiative comes to a close this year, a new iteration of the program will take its place. The CMS’s Center for Medicare and Medicaid Innovation (CMMI) recently announced a new voluntary episode payment model, BPCI Advanced, that will continue to examine the use of bundled payments as a way to improve care and reduce costs for common clinical episodes. The new program will include 32 Clinical Episodes, including multiple orthopaedic episodes. BPCI Advanced, like its predecessor, is a voluntary program, and the first group of organizations that choose to participate will begin on October 1, 2018, though an application must be submitted by March 12, 2018. BPCI Advanced will run through December 31, 2023, and organizations will have another chance to join in January 2020.

Two types of organizations can apply to participate in this voluntary program: Acute Care Hospitals and Physician Group Practices (PGPs). Both types of healthcare entities have specific knowledge and capabilities that will provide advantages for success in the program and give them a unique perspective and expertise in a program that aims to improve healthcare delivery for patients and providers. Not only are physicians’ voices an important component of reforming healthcare, but physicians have an opportunity to gain a lot themselves - both financially and experientially - by participating in BPCI Advanced.


Shape Future Healthcare Policy

Programs like BPCI Advanced are designed to inform the decisions made by health policy organizations as they work to improve and advance the delivery of healthcare on a national level. As payment models continue to shift from fee-for-service to value-based, physicians will have a unique perspective on the effects this shift is having on their practices and their patients, and should contribute their point of view to the discussions taking place. Participating in programs like BPCI Advanced guarantees that PGPs have a seat at the table for these important discussions.


Improved Patient Outcomes

The original BPCI program has produced data showing that a bundled payment program with physician engagement, skilled case management, patient optimization, and the effective use of data analytics can improve patient outcomes. Patient optimization is one of the best things to come out of bundled payments and improve patient care. Manageable risk factors are addressed prior to surgery to reduce the risk of adverse outcomes and ensure appropriate post-acute services. In our experience, PGPs across the country have reduced the 30-day readmission rate following elective lower extremity joint replacement by 28%.


Financial Advantages for Improving Delivery of Care

Healthcare is changing, and early adopters of new payment models and delivery systems have the chance to benefit financially by being willing to take on some risk. In BPCI Advanced, just as with BPCI, participants have the opportunity to reduce unnecessary costs and recoup some of those savings as payments from CMS. Physicians are eligible to receive an additional 50% of their Medicare Part B fee for service claims billed within a performance period. 

Early adopters of care innovation will also have the advantage of gaining experience in government programs that can then be applied to the commercial sector. Many commercial health insurance programs are beginning to experiment with the bundled payment model, and will be eager to work with PGPs that have experience with these models.


Achieving Quality Goals

As organizations seek to meet the MACRA Quality Payment Program requirements, BPCI Advanced provides an alternative to the Merit-based Incentive Payment System (MIPS). BPCI Advanced qualifies as an Advanced Alternative Payment Model (APM) under the Quality Payment Program. Participants will have the opportunity to earn quality or partial quality provider status beginning in 2019 under the Advanced APM track


Physicians Leading Care Redesign

Physicians have an opportunity to gain experience in bundled payments through BPCI Advanced. As participants, they have the opportunity to impact the future of physician leadership in value-based care as well as future programs by sharing their perspective, successes, and concerns along the way. Physicians with the opportunity to do so should embrace the challenge to improve patient care, drive national care redesign, and take advantage of financial incentives as an early adopter of bundled payments.

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About the Author

Ann Conrath, MSW, LCSW is an Account Manager at Signature Medical Group, Inc. (SMG) a multi-specialty physician group with nearly 150 physicians in 17 specialties primarily located in St. Louis and Kansas City, MO. Conrath has worked in several capacities within the healthcare field, including political advocacy, community organizing, research, and direct patient care. In her current role at SMG, Conrath has worked to create, structure, and implement several value-based care initiatives, including maternity care home models and orthopaedic bundled payments. SMG is the largest orthopaedic convener for the Bundled Payments for Care Improvement (BPCI) initiative and Conrath actively manages ten orthopaedic groups in the Southeastern region to improve patient outcomes, reduce unnecessary medical expenses, and maximize financial opportunity in this government value-based program. She is dedicated to improving the alignment between financial incentives and quality care within our healthcare system.

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