Bundled Payment Pilot

Dissecting DRGs for Bundled Payment

Will Submitting PRO Data Increase Your CJR Payments?

by Jonathan W. Pearce, CPA, FHFMA, Principal, Singletrack Analytics, LLC and Steven Wood, PhD, VP of Research and Strategic Partnerships, CODE Technology

Chasing the Rabbit – Keeping Up with Changes in the CJR Regional Targets

By Jonathan Pearce and John Kalamaras

What to Look For In BPCI Advanced

by Jonathan Pearce and Darcie Hurteau

Many current and potential bundled payment participants are eagerly awaiting the announcement by the Centers of Medicare and Management Services (CMS) of the revised Bundled Payment for Care Initiative (BPCI)" program. This “BPCI Advanced” program has been planned by CMS for many months, but announcement of the details has apparently been stalled somewhere within the government.

CMS Drops Half of the MSAs from CJR

How Outpatient MJR Surgery Affects Bundled Payments

CMS has recently proposed to remove total knee arthroplasty (TKA) surgical procedures from the Medicare "inpatient-only" list, which would allow those procedures to be performed on an outpatient basis.

CJR Reconciliation – Maybe You CAN Take It to the Bank

In our previous article on this topic we suggested that participants in the CJR program shouldn’t expect the amounts in their initial Performance Year 1 (PY1) reconciliation to be final, and should instead expect their NPRAs to decrease in the final reconciliation that will occur in 2018. This is because claims will continue to be processed until the final reconciliation, so episode costs will increase while targets will remain constant.

Why You Shouldn't Take the Initial CJR Reconciliation to the Bank

Okay, you can take it to the bank, but you shouldn't book it in your financial statements or pay it out in gainsharing payments. That's because the reconciliation is likely to change significantly when the performance period is re-reconciled next year, and the change will most probably occur in a negative direction.
 

Mandatory Bundled Payment Participation - Comments on Health Affairs Article

The Health Affairs Blog published an article on Aoril 10, 2017 entitled "How Should the Trump Administration Handle Medicare's New Bundled Payment Programs?". That article describes and compared several options regarding the participation of physicians in these programs, as well as the mandatory or voluntary nature of those programs. Our comments on that article are below:

Physician Risk-Sharing in Medicare Bundled Payment Programs

I was quoted in an article entitled "Bundled Payments: What Doctors Need to Now" in the April 2017 issue of Medical Economics, which offers some guidelines to physicians about participation in these programs. This article expands on some points made there, and provide some additional considerations for physicians who may wish to participate in these programs.

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