Bundled Payment Pilot

Dissecting DRGs for Bundled Payment

Combining Clinically-Similar Bundled Payment Episodes to Reduce Risk and Improve Care

Jonathan Pearce, CPA, FHFMA and Coleen Kivlahan, MD, MSPH

The Medicare Bundled Payment for Care Improvement (BPCI) program allows participants to assume financial risk for all Medicare services occurring within 30 to 90 day period after hospital discharge. Model 2 participants give up 2% of the episode target amount as a discount to CMS in 90-day episodes, but are allowed to retain any savings from Medicare cost reductions below the target amounts.

Another Look at BPCI Risk Track Selection

As the deadline for submission of April 2015 applications for the Bundled Payment for Care Improvement (BPCI) initiative looms, many applicants are trying to figure out the best approach to selecting risk tracks for various episodes. Some participants are looking for "algorithms" that can assist them in selecting the most appropriate risk track, while others are noting that risk track can be changed throughout the participation period, and may wish to switch risk tracks based on their performance during a previous quarter.

Why Some DRGs May Never Be Appropriate for Bundling

 Initially some BPCI participants were intrigued with the idea of participating in limited, procedurally-based episodes such as percutaneous coronary interventions (PCI) episodes in the Medicare Bundled Payment for Care Improvement program.

Analytics Challenges for Advanced Payment Systems

We've frequently commented on the need for up-to-date skills and computer hardware and software to be able to analyze the data that accompanies participation in capitated and bundled payment programs.  This HIMSS article highlights some of those issues and the barriers that they present to successful participation.

How BPCI Episode Precedence Affects Health System Strategy

Jonathan Pearce, CPA, FHFMA and Coleen Kivlahan, MD, MSPH

Many participants in “Phase I” of the Medicare Bundled Payment for Care Improvement (BPCI) program were surprised by their first look at the impact of CMMI’s BPCI precedence rules when comparing  two sets of baseline data recently provided by CMS. This data show the number of episodes and target prices for episodes under two scenarios:

Which Episodes Should I Bundle for BPCI

by Jonathan Pearce, CPA, FHFMA and Coleen Kivlahan, MD, MSPH

Applicants to the Medicare Bundled Payment for Care Improvement (BPCI) program will be busy spending December identifying episodes for which they should participate when they "go live" in April. Several episode families are common candidates for participation, and an overview of their characteristics is described below.

Republican Plan for Medicare Bundled Payments Proposed

A new proposal for a permanent, voluntary Medicare bundled payment program was included in the discussion draft of a bill in the House Ways and Means committee. This proposal is similar to the current BPCI program, and has the following characteristics:

CMS Announces Significant Changes in the BPCI Reconciliation Process

Note: this article was updated based on a webinar from CMS on 11/6/14.

BPCI Episode Selection – An Analytic Approach

Achieving success in the Medicare Bundled Medicare Bundled Payment for Care Improvement initiative requires analyzing historical data to identify the opportunities and risks associated in each of the episode families, as well as the other decision points in BPCI participation. Careful evaluation of opportunities and risks before making participation decisions can pay off significantly when the at-risk period begins.

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