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Three Operational Issues to Look for in the BPCI Advanced Announcement

By: Darcie Hurteau and Jonathan Pearce

DataGen’s article was recently featured on www.ajmc.com.

Many current and potential bundled payment participants are eagerly awaiting the announcement by CMS of the revised Bundled Payment for Care Initiative (BPCI) program. CMS has planned this “BPCI Advanced” program for many months, but announcement of the details has apparently stalled somewhere within the government. This raises concerns for the many current BPCI participants who are hoping to continue
their participation in an ongoing program, as well as the hospitals and physicians who did not participate in BPCI, but may now wish to join the program.

The attractiveness of BPCI Advanced will depend on multiple, currently unknown, factors. In an earlier blog post, we weighed in on the program’s most significant programmatic details that we are waiting to see; however, that’s only half of the equation. For healthcare organizations participating in BPCI now—or considering how they can prepare to participate in BPCI Advanced—understanding how BPCI Advanced will
change the operational aspects of the program is critical for strategic planning.

Current and potential BPCI participants are looking for answers to 3 key operational questions about BPCI Advanced:

How will quality metrics be defined? 

In the current BPCI program, quality metrics are not used to affect financial performance; however, in the Comprehensive Care for Joint Replacement (CJR) program, a participant’s quality scores determine the CMS discount applied to the episode targets. Participants with high quality receive a higher target, while participants with low quality may be denied payment of any surplus that they may have earned. The selection of quality metrics and their applicability to payment will be a significant factor in the BPCI Advanced program.

One of the challenges participants in CJR and CMS’ Oncology Care Model know well is the data lag on their performance metrics. In the current models, participants receive information based on data that are 3 to 6 months old, which creates a lag in how they adjust performance and workflows, which means they may face penalties without being able to do anything about them. Hopefully, BPCI Advanced will improve on how quality metrics are defined and used—and set up more effective reporting timelines.

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