Bundled Payment Pilot

Dissecting DRGs for Bundled Payment

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.

The Medicare Bundled Payment Program Moves Forward

Over the summer the Medicare bundled payment model gained momentum as the primary vehicle for next-generation provider payment. This was due to two factors. The first was the unexpectedly high participation rate in the third wave of participation in the Bundled Payment for Care Improvement (BPCI) program. According to this Modern Healthcare article more than 6,000 providers have signed up to receive data to evaluate participation in BPCI, or are already at risk in this program.

Evaluating Your First BPCI Reconciliation

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.

Estimating Financial Risk in Medicare Bundled Payment

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.

Random Variation in BPCI Episodes Requires a Long-Term View

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.

Making Sense of the BPCI Mock Reconciliation

"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.

Why Medicare's Bundled Payment is Better than Commercial Programs

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.

Evaluating Opportunities in the Medicare Bundled Payment Program

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.

The Strange Financial Interactions Between Medicare ACOs and Bundled Payment Participants

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