7.31.19
CMS has offered a second application period for organizations considering participation in BPCI Advanced. Many organizations have submitted the nonbinding application to receive detailed claims data that will provide valuable insight into organizational performance across the 37 inpatient and outpatient episodes, 以及急性期后的表现. 理赔数据计划在9月份由CMS提供. Participation decisions are due in November, creating a limited amount of time to review the data.
Organizations considering participation in BPCI Advanced should evaluate participation from both a strategic and a financial perspective before making the decision to enroll in the program.
战略协调性
在组织从CMS接收索赔数据之前, 应评估其参与高级BPCI的战略适宜性. 许多组织开始着眼于更广泛的项目级契合度, then focusing on service line strengths and/or episodes that may be of interest or show financial opportunity. We have outlined some of the key components that would help determine the extent to which BPCI Advanced is a strategic fit for an organization.
组织准备
Organizations that have experience with value-based payments or want to learn more about these programs are in the best position to participate. These organizations may already have value-based contracts in place or be in the process of developing such contracts. We find that these organization typically place a high strategic priority on participating in and learning from value-based payment models. A bundled payment program like BPCI Advanced provides an opportunity to focus on a targeted population over a short period of time (admission/procedure plus 90 days), 同时对财务风险和机会有清晰的认识.
云顶集团40011官网对齐
BPCI Advanced allows organizations to share any savings in the bundled payment with participating physicians through a contractual gainsharing arrangement. Such arrangements provide physicians with quality and financial incentives that encourage them to meet organizational, 操作, 通过改善护理和降低成本来衡量质量(医疗保险支出). 如果有任何云顶集团可以受益于增加医师对齐, implementing the gainsharing model is a good opportunity to strengthen the service line and enhance your physician strategy.
所有的合作
急性后护理是BPCI高级项目的关键组成部分, 因为所有发作都包括入院或手术后90天内的财务风险. Selecting the optimal post-acute setting for the patient will ensure the appropriate and most cost-effective level of care and reduce costs. Participation in BPCI Advanced requires an organization to understand its post-acute network and effectively manage care throughout that network. 经常, organizations need to develop a preferred network using measurable data such as quality ratings, 停留时间, 重新接纳, 等. 为了评估绩效. BPCI Advanced offers an opportunity to develop more collaborative working arrangements with post-acute care providers.
信息管理
了解BPCI Advanced的性能, 组织将需要收集和分析财务, 操作, 质量数据. Information management capabilities that allow for reporting of key information will help leaders manage patients and providers more effectively. Organizations will need to take a multidisciplinary approach to organizing input and participation from multiple functional areas, 包括质量, IT, 数据分析.
剧集选择的财务方面
一旦组织收到来自CMS的索赔数据, 它可以开始回顾和分析信息. This review will assist in making an informed decision regarding which episodes to select. 注意事项包括:
- 剧集数量.
- 再入院和急性后用药.
- 章节成本与目标价格的比较.
剧集数量
37次临床发作, CMS只考虑那些有足够容量的, which is defined as a minimum of 41 episodes initiated at the hospital over a four-year base period. 即使它达到了41集的最低门槛, 组织可以将某一集视为低容量, 有更大的财务风险,没有足够的财务机会.
再入院和急性后用药
Organizations will also need to consider post-acute utilization and the corresponding spend in their episode selection process. The data typically reveals that total post-acute care cost represent 50% to 80% of the total spend. One could view these higher post-acute care costs as a risk or as an opportunity to manage these patients and reduce the utilization. 在心电图的经验中, organizations with a defined and aggressive post-acute care management strategy are having good success with BPCI Advanced.
It is critically important to partner with skilled nursing facilities and inpatient rehabilitation centers that focus on achieving reasonable lengths of stay and reduced hospital 重新接纳s. BPCI Advanced participants have an opportunity to develop 操作 and quality metrics with post-acute care provides aimed at reducing unnecessary utilization and spend while improving quality.
章节成本与目标价格的比较
最后, organizations will need to select episodes in which they are confident they can achieve a lower cost compared to the target price. 经济上的考虑是关键, as it will determine the likelihood that an organization will have a spend below the target price, 在高级BPCI下产生财务盈余. 章节成本与目标价格的比较 can be evaluated historically through the CMS claims data, 其中包含三年的数据.
平衡战略和财务因素
Organizations are likely to be prepared in some areas and not as prepared in others, 根据上面概述的机会和风险. A comprehensive review of both the strategic and financial factors will assist an organization in determining its preparedness for BPCI Advanced. 心电图 views the episode selection process as both a financial and strategic exercise. 因此, organizations that take the time to complete a comprehensive review of the key strategic and financial factors will be in the best position to successfully participate in BPCI Advanced.