HCB News: Are providers able to calculate or project the likely benefits of participation?
TJ: Yes, to be sure—and they should get a clear sense of that number and the likelihood of reaching it before they enter the program. One of the nice features of BPCI Advanced versus traditional models is that CMS is giving providers pricing ahead of time. By looking at your data and engaging your physicians, you can immediately identify the low hanging fruit. You’ll want to then develop a hypothesis about their ability to truly lower unnecessary costs. (Some of that improvement will have to come from pre-admission engagement, by the way.) You should also go into the program with a solid plan for splitting up the gains in a smart and fair way. With the right economic models and better patient management, providers can really advance everyone’s interests.
HCB News: That’s an interesting point. Do the benefits get evenly spread around?
TJ: One of the things this model still leaves open is it cuts off post acute care providers from being post acute care initiators. What that tells us is that CMS really believes that hospitals and medical groups are in the best position to manage patient outcomes and costs. As compared to the mandatory total joint bundled payment program, CJR, physician groups can take a leadership position and become the initiators of the bundles. Because of this you’ll likely see medical specialty groups getting aggressive and trying to cut out hospitals from a gain sharing perspective, so hospitals need to be mindful about engaging with their doctors early to ensure alignment.
HCB News: What does being “ready” for BPCI entail?
TJ: With these specific programs the first step is “know your data.” Nothing is keeping providers today from downloading their data from CMS to see how they have done in the past. They can do that by visiting https//:innovation.cms.gov/initiative/bpci and downloading a data request and attestation form. Anyone can do that, and everyone should.
Once you’ve made a commitment to jump in, there are a number of things that can be done to drive performance. One is reducing the amount of unnecessary post acute care. By discharging patients to skilled nursing or rehab facilities and carefully monitoring their utilization, or by safely discharging them to their home, providers can improve financial performance while maintaining excellent quality.
The essential tool here is an effective care management team to carefully monitor the patient’s progress once he or she is discharged from the hospital. This management should include a patient engagement platform that gives them accurate, tailored information about what they should do at home and what to look out for. Engaging the patient to be on the lookout for an adverse event is empowering, and it also means they and their providers can identify adverse events early and treat them in cost efficient ways.
