On January 9, 2018, The Centers for Medicare and Medicaid Services (CMS) published a rule announcing the Bundled Payment for Care Improvement Advanced program (BPCI Advanced), a new voluntary bundled payment program.
This program will succeed the current voluntary BPCI program that ends in September of this year, which allowed participants to take risk on 48 episodes of care. The current program overlaps with the mandatory Comprehensive Care for Joint Replacement (CJR) program, which requires hospitals to take risk on the total joint replacement of the lower extremity (TJR) episode of care in 67 markets around the country, but was recently made voluntary by CMS in 33 of the markets. BPCI Advanced allows participants to take risk on 32 episodes of care, including TJR. Stryker’s Performance Solutions is a “convener” (a third party taking risk and providing support on episodes of care initiated by participating physician groups and hospitals). In the current BPCI program for the TJR episode of care, Performance Solutions provided convener-like support service for participants in the CJR program, and will again act as a TJR convener for the BPCI Advanced program.
There are several good reasons to apply for the new BPCI Advanced program.
• Firstly, CMS provides applicants with valuable claims data on all episodes of care that participants initiated during the four-year baseline period (2013 – 2016). Analyzing and reviewing this data provides important information about episodes cost and practice patterns across all providers, allowing the development of strategies to improve quality while reducing costs (the cornerstones for success in all value-based programs), and is reason enough to apply for the program.
• Another reason to apply is the opportunity to profit from episode savings that can be generated. Participants in Performance Solutions’ current BPCI convener generated average savings of $2,300 per episode, a 21% reduction in readmission rates and a 30% reduction in post-acute costs. It makes sense to see what opportunity your organization has under this program.
• An additional motive to apply is to learn about how these new value-based programs work. Value-based initiatives have broad bi-partisan support in Congress and are likely to continue to expand, gradually replacing the fee-for-service system. Learning how to succeed in value based programs is an essential strategy in today’s rapidly changing health care environment.
In the BPCI Advanced program, physician groups and hospitals will be able to participate by either directly taking risk on episodes of care or by joining a “convener” that takes the risk on the episodes, such as the one created by Performance Solutions.
Performance Solutions believes that the best way for most physician groups and hospitals to participate is by joining a convener rather than taking the risk directly from CMS. Most physician groups and hospitals are not experienced at administering such programs or taking risk (especially the downside risk of episode losses) and do not have the data analytic, care management and patient engagement infrastructure needed for success in this program. By joining a convener, the physician group or hospital can share (or even eliminate) the downside risk and access the infrastructure needed for success. Performance Solutions provides dedicated Program Managers and deploys our highly valued Episode Performance Manager data analytics dashboard and our JointCOACHTM care management and patient engagement platform to its convener participants. Our clients stress that this infrastructure has been essential to their program’s success.
Another reason for a physician group or hospital to apply through a convener as opposed to taking the risk directly from CMS is the lengthy and complicated application that must be submitted. Completing the application will require the dedication of very substantial resources in the next few weeks and there is the risk of having the application rejected by CMS if not completed properly or if the plans described seems insufficient to CMS. In contrast, applying to participate through the Performance Solutions convener is easy. All that is needed are a few easy to complete documents and we do the rest.
So, why apply now? The deadline to file or join an application is March 12, 2018. The next opportunity to join the program is in 2020. In our view, it makes sense to apply now through the Performance Solutions convener and preserve your option to participate in BPCI Advanced. There is no cost and no obligation to apply. We will obtain the CMS claims data for your episodes in May and analyze that data to show you your opportunity. Binding decisions on whether to participate do not have to be made until July. But why not take the easy step to apply through the Performance Solutions convener by getting us the few documents we need by March 1st? For more information on how to apply, please contact us at spsinfo@stryker.com.
Paul Jawin, JD, Vice President, Alignment, Stryker’s Performance Solutions
Paul brings more than 35 years of legal, business, financial and capital markets experience to his role in developing physician alignment and payment reform programs. A co-founder of Comprehensive Care Solutions—acquired by Stryker in 2012—he has helped physician organizations and health systems align and turn reform into opportunity by utilizing new payment and delivery structures, including Accountable Care Organizations and bundled payments.
Paul is a regular speaker at industry conferences and events. He co-founded and served as Senior Vice President and General Counsel of Secured Independence, Inc., and has held senior executive positions with public and private companies involved in real estate and senior housing. Paul has a Bachelor of Arts degree in History from Ithaca College, and practiced corporate, securities and real estate law in New York City for more than 10 years after graduating from Syracuse University School of Law with a Juris Doctor degree.
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