BPCI Advanced: Model Year 3

Compare participation by BPCI Advanced Clinical Episode Category

As the BPCI-A program matures, participants have dropped certain episodes and picked up others. To get a better understanding of where those changes occurred, we have developed this visualization tool. You can choose which clinical episode categories you wish to see, and easily compare data from model years 1 and 2 with model year 3.

We have included additional analysis of this data at the bottom of this page.

The percentages displayed below indicate the growth or decline in participation in a clinical episode category proportionate to the total volume of participants in each model year.

 

Analysis

Category Changes

It’s important to note that the Centers for Medicare and Medicaid Services (CMS) made several changes to the clinical episode categories available in model year 3. This included the following:

  • The addition of four new clinical episode categories:
    • Bariatric surgery
    • Endovascular cardiac valve replacement
    • Inflammatory bowel disease
    • Seizures
  • Major joint replacements of the lower extremity evolved to include both inpatient and outpatient episodes
  • Spinal fusions were consolidated from three separate categories into one clinical episode category

Participation

Model year 3 also saw significant growth in participation. More than 700 new providers entered the program for model year 3: nearly 300 new acute care hospitals and 450 physician group practices.

Episodes for medical conditions saw the greatest growth from model years 1 and 2 to model year 3. The clinical episode categories with the most growth included:

  • Sepsis (+464)
  • Chronic Obstructive Pulmonary Disease, Bronchitis, Asthma (+291)
  • Acute Myocardial Infarction (+279)
  • Simple Pneumonia And Respiratory Infections (+244)
  • Renal Failure (+232)

Decreases

There were only four clinical episode categories that saw a decrease—interestingly, all of these episodes are for musculoskeletal and connective tissue conditions:

  • Fractures Of The Femur And Hip Or Pelvis (-19)
  • Major Joint Replacement Of The Lower Extremity (-24)
  • Lower Extremity And Humerus Procedure Except Hip, Foot, Femur (-65)
  • Hip & Femur Procedures Except Major Joint (-75)

Top Episodes

Finally, the top 5 most selected clinical episode categories for model year 3 are:

  • Sepsis (898)
  • Cardiac Arrhythmia (688)
  • Chronic Obstructive Pulmonary Disease, Bronchitis, Asthma (645)
  • Acute Myocardial Infarction (623)
  • Simple Pneumonia And Respiratory Infections (622)

 


 

DataGen’s industry-leading analysts have unpacked troves of episodic data to help you learn what kind of participation is right for you.