New CMS Announcements for BPCI-A Model Year 4

DATE: 06/25/2020

The Centers for Medicare and Medicaid Services (CMS) only just announced flexibilities to its bundled payment programs due to COVID-19. As of June 18, CMS made an additional announcement for participants and episode conveners in the Bundled Payments for Care Improvement Advanced (BPCI-A) program.

Participants should make their clinical episode decisions with care. Ensuring they choose the most advantageous episodes for their organization is vital, because episode selection is a key factor for program success. Making these determinations requires participants to have deep insight into, and understanding of, their own episode-specific data. This knowledge serves as a baseline for participants to choose the episodes they can achieve success in, and develop a strategy to get there. Our data analysts recommend that participants ask themselves four key questions:

  1. Has my organization reached a critical volume of episodes in any given category to ensure an outlier episode can’t tip the scales out of our favor?
  2. Do we understand our fixed and variable costs for each episode?
  3. Do we understand what’s driving costs after discharge?
  4. Do we have strategies to reduce readmissions?

These are key starting points to determining the episodes that are appropriate for an organization.

Adding a layer of complexity are the options CMS announced three weeks ago to create program flexibility for participants with episodes impacted by COVID-19. Participants will have to decide between three paths removing all upside and downside risk, removing just COVID-19 patients from calculations, or continuing to participate as usual, in addition to determining which clinical episodes to participate in for Model Year 4.

CMS also announced that it will not open another application opportunity for new participants or new episode initiators to join BPCI-A.

More dates and specifics on these statements will be forthcoming from CMS. In the meantime, DataGen can help your organization answer the four questions above, assess your clinical episode categories and determine the overall best path forward to take in Model Year 4.

Contact us to learn more today.