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Posted by Jeff Peters on Jan 15, 2018 10:31:39 AM
Jeff Peters

CMS announces Bundled Payment for Care Improvement (BCPI) as a voluntary program

CMS Bundled Payment

On January 9, CMS announced a new voluntary value and quality based payment program called Bundled Payment for Care Improvement (BCPI). The application period for signing up for the program began on January 12 and will end on March 12 at 11:59pm. The next sign-up period is expected to take place in January, 2020. So, the time is now if you want to try this program, else you will have to wait two years.

There has been a lot of questions swirling around CMS’s bundled payment programs for the past year or so since the mandatory programs began being either cut back or eliminated altogether. BCPI is the Trump Administration’s first new value payment program since taking office a year ago. The demo program is scheduled to take effect on October 1, 2018, following review of the applications.

The voluntary bundled payment program allows hospitals to collaborate with surgeons, providing an opportunity to get higher payments by looking at their treatment programs more holistically in order to ascertain impact on outcomes and costs. For example, surgeons at one hospital noticed that around 50% of their joint replacement patients went to rehabilitation or skilled nursing facilities following surgery.[1] Not only did they discover the outcomes were no better than for patients who simply went home, admission to those facilities often interfered with a hospital’s ability to follow-up on any issues within the 90 day period proscribed by CMS’s program. Without the incentives in place to do this kind of analysis, the hospital and surgeons would have continued to miss this connection, and thereby miss additional financial opportunity.

The application process involved contains four part, the primary application and three appendices[2]:

  • Application template (PDF)
  • Attachment 1 – Data Request and Attestation (DRA) Form (PDF)
  • Attachment 2 – Participating Organizations List (XLS)
  • Attachment 3 – PGP Practitioners List (XLS)

Application materials for the program must be submitted through the CMS application portal. With the deadline now less than two months away, hospitals and physicians interested in participating must move quickly. By getting a handle on total treatment costs and outcomes, hospitals and surgeons will be better positioned to command a larger share of the bundled payment. This sort of win-win opportunity does not present itself every day!

Surgical Directions is a healthcare consultancy specializing in perioperative transformations and staffing solutions. Given the short time frame for BCPI applications, we are happy to offer our assistance to help you scope your participation properly. There are 29 different clinical episodes covered by the program, so setting scope thoughtfully is the first major decision. For more information on how we can help, please contact us at info@surgicaldirections.com.

[1] http://www.modernhealthcare.com/article/20171007/NEWS/171009950

[2] https://innovation.cms.gov/initiatives/bpci-advanced

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