Most BPCI participants will undergo their first BPCI reconciliation in October, which will cover the first quarter of 2014. We’ve heard that some participants appear to be basing their ongoing participation in the BPCI program on these results. If a surplus occurs, they’ll stay in the program and may even add additional episode families. But if the results are negative, they’ll be jumping ship faster than the captain of the Costa Concordia.
In our previous article on this topic we discussed ways in which randomness in patient selection causes variations in average episode costs. Even for higher-volume DRGs, these variations can create significant differences in the settlement amounts during CMS reconciliations. In this article we describe a simulation methodology that allows estimating the extent to which these variations will occur.
The randomness in episode costs has always troubled the Singletrack Analytics team. Even for high volume episodes, randomness makes it difficult to gain a good understanding of financial performance. After CMS released the mock reconciliations, we started wondering how much variation would be present in the quarterly average costs that would be reconciled throughout the performance period. This triggered the analysis below.
"Shock and awe" were words that many of our clients used when they received their ”mock” reconciliation data from CMS in early May. Some were dismayed at the significant reduction in financial surpluses from those that were expected, while others were alarmed by several apparent policy changes that have been implemented without notice and after contracts were signed. This article will discuss what we expected to see, what we actually saw, what we see as the consequent effects on reconciliation, and where we believe policy changes must be forthcoming.
A professional colleague recently commented that some of his clients were considering bypassing the Medicare Bundled Payments for Care Improvement (BPCI) program and were focusing on pursuing bundled payments with commercial payers. As we’ve previously written, we think that BPCI is one of the best advanced payment system options available, and it worthy of consideration by almost every hospital.
The Medicare Bundled Payment for Care Improvement (BPCI) program offers hospitals and post-acute providers the opportunity to work collaboratively to coordinate care occurring during and after an inpatient stay, and to retain most of the savings that may be generated as a result of the elimination of unnecessary provider services. The Centers for Medicare and Medicaid Services (CMS) is allowing providers that are already participating in this program to evaluate expanding their participation to additional episode families.
Once advantage of working with many clients is the diversity of situations that you get to see. So when we got a call that a client wanted to discuss the merits of the various selections of risk tracks under the Medicare BPCI bundled payment initiative, we gathered the team together for a conference call.