Participants in the Medicare bundled payment programs hope to achieve positive financial results by revising care processes, focusing on particular elements of post-acute care, reducing medically unnecessary care and hoping that the resulting cost savings will fall to their bottom line. In many cases this will occur.
In evaluating episode participation in the BPCI Advanced program, evaluation of targets can provide significant guidance in selection of episodes with high probability of financial success. This article explores the process for evaluating targets in the BPCI Advanced program.
As described in this Singletrack Analytics blog article, the three target adjustment factors (efficiency, patient case mix adjustment (PCMA), and peer adjusted trend (PAT) can vary widely among hospitals in episode types.
Along with the BPCI Advanced claims data, CMS provided to applicants with an Excel workbook named 2018_05_31_bpid-0000_Baseline_MY_1_2_Prelim_TP.xlsx containing the preliminary targets for all episode types in which the hospital had sufficient baseline episode volume. Those workbooks also contained the three factors that are used to adjust each hospital's baseline cost to compute the final target amount.
CMS has finally released the long-awaited specifications for target price computation for the BPCI Advanced program. This document provides general guidance into the process used to determine these targets, but many details will not be clear until the actual targets are released.
CMS recently released an updated "frequently asked questions" document for the Comprehensive Care for Joint Replacement (CJR) program. Of interest in that FAQ was statistics regarding the number of hospitals currently participating in CJR. As most followers of mobile payment programs are aware, CMS reclassified 33 of the 67 formerly-mandatory Metropolitan statistical areas (MSAs) to be voluntary, allowing hospitals in those MSAs to cease participation in the CJR program.